Transcript
Mallory Smith (00:00) good morning. I need to turn my lamps off just a minute.
Erica Lloyd (00:10) Hey, good to see you again, Robin. How are you? Oh, I think you’re muted.
Robin Redd (00:20) Hey, there, I’m doing well. How about you? Good. It’s crazy. I actually unmuted it. And then when y’all hopped on it like remuted me, which is odd. Yeah, I guess that’s going to be a thing. I just can’t remember to unmute it.
Erica Lloyd (00:38) Oh, good. Well, great to see you again. I’m just pulling up some slides here. I had an it issue this morning. So I’m re getting set up… here we go. So, yeah, great to see you again. We could just jump right in. So thanks so much for sending that. So in the last 24 hours here, we, I figured what we could do for this time is let’s just let me just recap, make sure I heard everything correctly. It’s been about five minutes there. And then Mallory… put together a pretty cool just like chart like almost like a workflow chart. And so we’re going to do, Mallory will run point on like almost a workflow demo type.
Robin Redd (01:26) And.
Erica Lloyd (01:26) we’re not going to go super in the weeds on it. And usually we would show product, but I think it might just be too in the weeds for what you need. So it’ll be more conceptual and what we’ll use as a guide is that chart you sent us and so you can see where we’re checking the boxes on the criteria there. And then we can close out. Well, I think we could still send you the, we still need to send you the scoping questions and I know we’re scheduled for more time tomorrow. We can go through that and make that we can send over the scoping questions and then go through the proposal tomorrow. If that works?
Robin Redd (02:03) Yeah, that would be great. If it, I don’t just in case I didn’t hear you clearly. It sounds like we’re not going to actually see. I’m not going to see inside the actual process of the system itself today, can we spend a little time on that tomorrow? Well?
Mallory Smith (02:22) So we actually will show, I’ll show you a brief. So when we say we’re not going to show you like the mechanics behind the scenes, I’m not going to show you the integrations and all of that. Yeah, but I will show you how your team would be interacting within the platform or your team can view the committee files, things like that?
Robin Redd (02:36) Yep. That’s all I wanted to see. Thank you. Of course.
Erica Lloyd (02:41) Yeah, good call. Thank you. Okay. Sorry, Mallory and I were just working on the flow charts together.
Robin Redd (02:48) No, it’s fine. And I know that was a quick turnaround. I know it was a quick turnaround. So I really appreciate it. And please don’t stress. I can kind of read between the lines and fill things in. So no worries. Where’s your co pilot? Mallory? I don’t see your little white fuzzy friend.
Mallory Smith (03:07) She’s eating breakfast right now and I can’t interrupt that, you know?
Robin Redd (03:12) No, no. Okay.
Erica Lloyd (03:17) So, I think just spending five minutes here to summarize everything that we discussed between the conversation you had with Nicole, what we had yesterday, boiling it down, new business initiative. And did I get this right? Sanjay? Is he your CEO? He?
Robin Redd (03:33) Is our CEO? I report to our vice president of clinical operations, Amanda James. So the request is coming from her, but it’s you know, she works directly with Sanjay. So, yeah… she has basically her ask was, can you provide us with the process timeline and costs for standing up a credentialed network?
Erica Lloyd (04:04) Okay. And with that, it’s like you’ve already deemed this is the financially viable way is to vend versus build in house. And now it’s we’re down to let’s select a vendor and then you’re planning to present to elt, Amanda. Potentially. I don’t know it looked like your CFO was Roger. Yeah, they are across this at some point in the evaluation and then you’ll be making that recommendation of one vendor. Yeah.
Robin Redd (04:36) I can’t say that the decision at the elt level has been made to outsource versus pull it together in house. That would be my recommendation. I don’t think we likely even have the time to build it in house for that number of providers. So that would be my recommendation. I can’t say that they won’t come back and say, can you price what it would look like? Can you do the same thing to see what it would look like to stand up our own department? Honestly? I’m probably going to do that on the side anyway because I just want to have that prepared so that I can say here’s choice a here’s, choice BCD and E, I would recommend of the cvo choices, this would be my recommendation so that’s kind of where we’re going. And that decision will likely come from Amanda and our coos. We have a kind of a co coo position Sanjay definitely steers… our path. But I don’t know that he really gets involved in the operational decisions, if that makes sense. I’m not saying that he couldn’t, I’m just saying he typically doesn’t like we, you know, we like and Roger is our CFO and I mean, I work closely with him through all of our accreditations, but he’s really just looking for the bottom line like what’s the cost going to be? And has, have we already made the decision to pursue the business and what is the cost going to be? And, you know, looking at the two choices, you know, yes, I agree. That makes sense and let me sign off. So he’s… not overly involved in the process. He’s just, you know, making sure that we’re financially viable as we all, we do report to a board of directors.
Erica Lloyd (06:37) Okay. Is there, okay. So as we get further down the line, I’m sure if there’s a spend threshold that would need to then go to the board for review if.
Robin Redd (06:48) You know, likely.
Erica Lloyd (06:49) Yes. Okay. So it’s mark is the co CEO, is that mark?
Robin Redd (06:55) No, it’s Makai, Crowley. She’s a physician. She’s our, also our Cho… and rob alterman. Okay. So, and I don’t know if that’s even reflected on like the website, if that’s where you’re pulling it from because that’s the, that’s a change for probably in the last few months. Okay? So, mark is still with us. He’s just, he’s also a physician. He’s just focused more on like innovation. He’s just, they’ve just shifted around a little bit with who’s focused on what? Because we’re kind of rapidly growing. So.
Erica Lloyd (07:38) Okay. That’s a good problem to have.
Robin Redd (07:40) Yeah, yeah, yeah, it is. So I mean, if, and I’m sure that you probably have looked up guidehealth and Sanjay on LinkedIn because he’s very active… and, you know, sometimes he’s talking about our… you know, our direction. Sometimes I find out what we’re doing through his LinkedIn post. I’m like, okay, yeah, yeah, no, he’s great. He’s also a physician. It’s a physician run company. It’s a physician built and run company with the sole purpose of supporting physicians and patients. So, you know, it was born from guidehealth was born from practicing physicians who saw a need that wasn’t being met. And so it’s a pretty, it’s a pretty fulfilling place to work really. I mean, I’ve worked a lot of places and it, you know, you get to a point in your career where it matters that it matters what you’re doing and, you know, it matters, the impact it’s having and what the focus is. And when I say this company is empathy driven, it is throughout the culture of the company. It is the, I mean, and I’ve not been able to say that. I mean, I’ve loved some other places I’ve worked but I’ve never had that kind of a focus before. It’s really refreshing. I mean, I wouldn’t work somewhere that I didn’t like feel really good about what they were doing. If it was just about the bottom line, I’d be like, you know, you can do that anywhere… but they really, you know, they really do want to do things right? And but that said, you know, most CEOS are such visionaries that sometimes their excitement gets us a little bit farther down the path than operations is ready to, you know, to dive in on. So that’s where I, you know, that’s kind of where I’m coming in. It’s just let’s make sure that we are well poised in the team that’s making the contracting decisions, understands what the commitment looks like before they make it. So that’s why they’ve asked me to jump in yeah.
Erica Lloyd (09:58) That makes a lot of sense. Well, let’s thank you for giving us that overview. And as Mallory’s pulling up her screen, I’ll stop sharing here again because this is probably very, like I said, there are there’s financial, it’s probably a very big financial implication. But also it’ll help you serve more patients essentially when you.
Robin Redd (10:25) think about the mission.
Erica Lloyd (10:26) Because you’ll have more access, it’ll increase the access. But then when we get down to the financials, we just have so much experience on how to position this from the CFO lens and to the board lens of quantifying impact.
Robin Redd (10:41) That’s fantastic. Yeah, yeah.
Erica Lloyd (10:43) And really just understanding like, okay, is there a specific Roi multiplier that you need that, you know, with the CFO would approve? So even if, you know, if you want to champion something, we can help with the financial business case and say, okay, if it is, if it would cost you X, to hire these number of people, you know, medallion can do it this much faster with automation and you don’t need to hire these many people. And here’s what the total investment and the Roi would be, you know, three X, right? Four X5 X multiplier… and.
Robin Redd (11:15) I think that’s wonderful to know that. And I think that probably could come in really handy a little bit farther down the line. I think at this point, it’s they already know that a cbo partner makes a lot of sense. And so, I think they’re just trying to understand before… they sign a contract and make the commitment not just on time but on, you know, on compensation to understand what the cost would be to do it and do it right? And, you know, we will likely be in the behavioral health arena.
Mallory Smith (11:55) Okay.
Robin Redd (11:56) That’s what this is looking like. That looks like at least that’s the first network that we would likely be building that’s the strongest conversation we’ve got going right now is that’s the need we already have experience with behavioral health and have arrangements to do other services with managed behavioral health networks. We’re just not delegated for the credentialing and it’s not our network if that makes sense. So we’re not unfamiliar with it. We just, this is a, this would be a different situation where we would this time go build one and it would be our network as an LLC versus we’re being delegated for some of the functions surrounding a behavioral health network… credentialing not being one of those. So, I know it’s hard because even being in the organization, it’s hard to know which hat we’re talking. You know, you wear different hats. It’s not a, it’s not really a subsidiary. It’s a wholly stand, you know, a guidehealth network, LLC would be its own entity. Like it wouldn’t it doesn’t share the umbrella of say like a urac accreditation. Like it really is, this would be a separate entity. I mean, connected but not shared if that makes sense… because I’ve had to be really clear about that. Like we build this network that’s all well and good but it doesn’t get to use our like our urac accreditation because it is separate. So that doesn’t fall over… now, that can that network could delegate services back to the like organization of guidehealth mso. But it gets very complex and that’s really more of that’s out of my Lane that’s more of the legal department’s decision. So it’s I don’t know that that’s really important, I guess really just kind of to keep it simple and in the Lane is just standing up a network, you know, that’s the ask right now is just what does it take to stand up a new network?
Mallory Smith (14:18) Yeah. Sounds good. Well, let’s I’ll let Mallory take it away. Okay. Hey, let’s get into the feature function. Let’s get into the actual execution.
Robin Redd (14:30) Of it, the feature check. This is great. I’m very visual. So this is great.
Mallory Smith (14:34) Awesome. I can send this to you as a lead behind. I’ll blow it up on a PDF so that you have it as well. But this is just a really simple workflow. I’ll zoom in as we talk about each one. What we’re viewing here is just your typical onboarding provider, getting them credentialed, having your committee review them, and then they’re good to go. From there. I’m sorry.
Robin Redd (14:55) It looks a lot like the process flow that I’ve already created hey.
Mallory Smith (14:59) There you go. We’re speaking the same language.
Robin Redd (15:02) Perfect.
Mallory Smith (15:03) So, yeah. So then we have three swim lanes. Of course, we have your side. We have the committee, we have medallion. So where we’ll start is if I zoom in up here, go ahead and just drag this one down so the admin, the provider will be hired. They’ll add the provider using the medallion platform. I’ll show you what that looks like as a visual. In just a minute. From there, we’re going to transition down here to medallion. Is then able to auto import the caqh. So when the provider completes the onboarding process or your team completes it, all we need is the caqh id, last name and npi. And then we can automatically import caqh information that will be data and documents from there. The request to be credentialed will be submitted. We’ll run the ncqa primary source right now. It’s taking us about one business day on average because we do have 90 percent of it completely automated, three day guaranteed turnaround time for your team there. And then it’s going to produce a ncqa qualified cred file and an alert will immediately go to your different committee members. The important thing about the committee is that they are able to view all of this from the medallion platform electronically from their phone or tablet. They can vote at seven a. M. They can vote at nine P. M. They’ll be able to leave notes for other committee members. It can be voting asynchronously. I think the really sweet spot that you’re in right now is that you don’t have bylaws and policies, set up a delegated agreement as you become the network. So when you establish those bylaws and policies and procedures, you can just say virtual committee. So that way you can avoid all that. Okay? So then once the committee is alerted, the committee will then review the credentialing file. All within the platform. They’ll be able to vote. They can see how other people voted for the file. The vote is automatically logged in the platform. And then it’s added to the roster. So since you have your own network, it’s all under one tax id for now. Then it would be just alerted. The providers are now credentialed fast forward three years for ncqa recredentialing. There’s an auto renewal with the rescheduling. So an automatic application will be sent to the provider, so we can get that process started again. So very simple visual workflow for you today? Yeah.
Robin Redd (17:30) That’s perfect.
Mallory Smith (17:31) Just the deadlines, what would be required from each party that?
Robin Redd (17:35) Committee piece is fantastic. I love that because that… also kind of takes some burden off of internal staff. It basically just kind of bypasses that burden it does, which is really nice. I mean, you know, kind of when we were talking back to, I mean, the staffing. I mean there is a difference between like getting the information back, credentialing staff, having to sort through it or, you know, get it ready for presentation to a committee and then taking the voting information back and all of that just out of curiosity, do you have any, I guess knowledge or experience with how people handle like keeping minutes for a committee, if they handle voting in this manner?
Mallory Smith (18:26) Yeah, typically, there are areas to keep notes and minutes in the platform. So there’s notes on every single tab. I’ll actually show you where the committee members can keep their notes for each individual file. So it’s there, it’s historically tracked. You can come back to it six months a year and a half from now. If you need to as far as like a committee meeting, like specific area. I really, I don’t know if any vendor out here really has that right now. Typically, we’ll just see a shared document that most customers use that it’s what they’ve been doing for years and that would be the proper transition for them.
Robin Redd (19:02) I’m assuming all of these like votes and comments and things are protected by peer review.
Mallory Smith (19:07) Yes, yes. So everything is protected in there role based access, security, of course. So committee members can see the files and things like that.
Robin Redd (19:17) Perfect. So.
Mallory Smith (19:19) Then getting into it, what I’ll do is basically just run you through a visual workflow of what that process would look like. I think the really great aspect is when we’re thinking in just the area of ncqa level credentialing, there’s not much left on the provider at all. We typically have a two day average onboarding timeline because we do have that direct integration with caqh. You will have other vendors in the space, say that they can connect to caqh, but you have to have your username and password. You have to use an import utility module. We’re the only ones that you need the caqh id and that’s it. We don’t have to track the username and password to be able to access it. Okay. When your team logs into the medallion platform, they’ll see something similar to this view. A team member will essentially click invite provider. Now, this is different for you. We’re going to do a bulk import with your spreadsheet. I know that you’re looking to grow to 2,500 providers, at least with a bulk import. We just need their email, last name, npi caqh id. We’ll pop that into the system. A shell profile will be created for the providers. The caqh will be linked and then you can make a bulk credentialing request.
Robin Redd (20:31) Will you tell me what those things are again? Yeah?
Mallory Smith (20:34) Of course, the major points are last name, npi, caqh id and email.
Mallory Smith (20:52) And what that triggers is a profile in the system for the provider. It links their caqh. So it’s now completed at least 75 percent from the information in caqh… an email will go out to them to let them know that they are now going to go through their credentialing process. So this next part that I walk you through, if you do the bulk import and connect the caqh for the providers, all they’re doing is they’re logging in the platform, reviewing it, signing a few forms so that we can submit caqh that we’re authorized to use it. And then they’re pretty much done. So that’s why we see the two day average onboarding timeline.
Mallory Smith (21:42) And I’ll show you an example of what that looks like. So with the onboarding flow the providers will receive once you’ve linked them an email that looks something similar to this. We do allow white labeling. So you have the ability to put your own logo at the top, control the body of the message that goes out to them. Big picture. They click, get started. When they click, get started. If you are connecting their profile, then they’ll go straight to the provider profile. They’ll be able to review the information and this would be their view in the actual platform.
Robin Redd (22:21) Okay. So they.
Mallory Smith (22:23) can see their basic information, existing licensure, in addition to credentialing the provider to the three day guarantee, this is also now their repository. So they can store their usernames, their passwords in here. It is soc two type two compliant. So all their information is secure… credentialing contacts, malpractice insurance. These are things that you can all go through and bulk update as needed. So not only are you getting a credentialing platform, but you also have a repository for any other admin functions that you may need. Two other features that I’ll call out. Oh, wait, did you have a question on that one? No?
Robin Redd (23:02) So on the credentialing contacts, what is that? This?
Mallory Smith (23:07) Is more for payer enrollment purposes. So if we’re submitting payer enrollment applications and you want to be listed as a credentialing contact on those applications, it would be stored here.
Robin Redd (23:17) And then the external accounts, yes.
Mallory Smith (23:20) This could be examples such as their board login, npez, there’s fsmb. We do have an integration with them by the way and then add external account. Eric and I were on a call last week where they said, so they could store their Facebook password in here. And yes, they technically could… yes… continuing education credits. So they’re able to track it can be anything from the credit hours, title, start date, work type. So it really is a full repository of all the things that you think of when you think of provider data management. The other two features that I’ll show you before we get into the credentialing state flow is that under documents for the provider, we do have a QR Code scanner. So if they don’t want to take their diploma off of the wall, unpin it, find a printer scanner, they can just scan their phone over this QR Code, take a picture of it. Our system will, using AI and OCR technology, will save it as a PDF and even help name the document. So, should there be any additional documents that you need unrelated or related to credentialing, then you can send a task to this provider within the platform. They can use this feature. And if they’re on the go, they can upload it great, the last great piece of it mobile view. So they can do this from their phone or their tablet. They have the ability of reviewing their profile information, reviewing their task. We have electronic signature integration.
Mallory Smith (25:00) If I open up the profile and click agreements, they have the ability to review the authorization forms, letting us access their caqh information. They can add their signature sign with their finger, and then finally save and finish. And then that’s the provider’s done at that point.
Robin Redd (25:21) Nice. And now,
Mallory Smith (25:24) we got, ooh, four minutes left. I can do it. I can do it. We got this. Okay. So if we go into credentialing, what’s going to happen next for your team? Once you’ve imported the provider, then you go to the provider tab, you invite them next, you go to the credentialing tab. You’ll come up here to request, go click provider, initial credentialing, you’ll select the new providers you want to go through it or the existing. If it’s recred. This really wouldn’t be a thing for you because you’re currently set up for auto renewal with credentialing, once you identify those providers, they’ll now be added to the queue. You get full visibility as you’re going throughout this process, you’ll be able to see exactly which elements have been versus what has not been verified? Our team on the back end is verifying all of this for your team? So we’re going to have the completed packet. When it is in the request, we’re going through, we’re processing it, we’ll then transition it to the ready area. This is where you’ll be able to see clean file versus flagged file. So you do have the ability to filter. I know that was something you mentioned yesterday that you want to be able to see the 50 flagged versus the 1,000 clean. So you do have the ability to see that you can of course, export any type of report. This is something that our credentialing committee loves. So comprehensive audit history of course, shows you the, how, what when, where and why on how it was ncqa verified. You can download this and it includes all the supporting documentation that we collected as part of the process. And then finally, your committee members can leave notes to the right and say approved with contingency based on xyz. They can post it. This is just this area for the providers to be able to go through and leave their notes.
Robin Redd (27:17) And then how does that show up? I guess, so is the, are these popping up like as soon as they’re ready? Or do we set like a date where, you know, a list of clean pop up or either whether that goes to the whole committee or to a medical director, and then the ones that need to be reviewed individually? I guess I’m just trying to figure out, is that something that they’re going to constantly be getting alerts as files are ready or is there like can we schedule a date where that information pops up for them? Or how does that work?
Mallory Smith (27:53) It can go either way. So typically, that would say the standard is that when we have reviewed the files and we’re ready to go ahead and send it, then I would select clean versus flagged. And then it’s going to send it to the committee. The committee members would then get an alert that Naomi’s file is complete and ready for the review. They can approve it or reject it once they open up the packet. Once they leave their notes to the right. So they can get an auto notification for every single file as soon as it’s ready. Or if you would rather have it more within your policy that on every Monday, you review the files that are ready for your review, we can do it that way too. Okay?
Robin Redd (28:35) Nice. Okay.
Mallory Smith (28:37) Yeah, of course. So right now, we’re seeing the committee view. So the committee would be able to see that, hey, Naomi’s file is clean. Let me open this up. Let me review the different aspects. I don’t have any questions at this time. I can leave my notes here as a committee member. Other committee members can see my notes. It’s just if I see something I want to flag it. And then finally, as the committee member, I can approve and reject. Once it is approved or rejected, it then heads to the closed area. This can be where the outcome is stored for all providers. If they are approved, archived or rejected, you’ll have visual indicators for each aspect. And then finally the scheduled recreds. This is something that is automatically added to that queue.
Mallory Smith (29:24) So, if the provider was credentialed, October first 20 26, then 60 days before October first 20 29, they’ll get an alert to go through the recredentialing process. So, for archive, what?
Robin Redd (29:37) Would archive be used for?
Mallory Smith (29:40) Termed providers is usually a good example. It’s someone that’s no longer with the organization. Therefore, you don’t need to recred.
Robin Redd (29:47) Just inactivate some. Basically, it does. Okay. And the,
Mallory Smith (29:52) good news is that if you have 2,500 seats in the platform in one term, you’re now able to reuse that seat. So you don’t have to purchase a whole new seat, you do have the ability to backfill.
Mallory Smith (30:04) Okay. And that is, the cred flow. I’m sorry, Erica, was this for 30 minutes or 45 45? Thank you. We’ve got time. Okay? Robin, I can run back through anything that you have. I’m sorry, I thought we had 30,
Robin Redd (30:17) I’ll pause.
Mallory Smith (30:19) I’ll answer any questions you have now.
Robin Redd (30:21) I mean, I’m loving this committee function. Awesome. I mean, that’s I feel like that’s a huge time saver. I think my physician leadership would love that. I think they are, you know, already a little bit dreading the whole traditional committee… meeting, lots of time. Lots of just, I mean, thoughtful consideration and discussion is always important, but I think, you know, the coordination of schedules and everybody doing things at one time and being like on a call together. And, that’s a lot that’s a, that’s difficult especially when you have, you know, physicians are spread out across different areas and even just times that, you know, that’s tricky. So I do think that that’s a huge plus that especially that they have the access on their phone. I mean.
Mallory Smith (31:26) Yes.
Robin Redd (31:27) That’s really nice.
Robin Redd (31:33) I have a note here. So what just asking in fairness? So from your standpoint, what are things that medallion is like focused on for improvement? What are things that you feel like are in process? That are, you know, like maybe you’re not quite up there that medallion if there are some growing pains that, you know, it’d be great for me just to kind of know and be prepared to just be ready to kind of rally around that.
Mallory Smith (32:08) Sure. That’s a great question… in what areas?
Erica Lloyd (32:15) Robin, are you thinking about?
Robin Redd (32:20) I guess more in terms of the platform, the process… I mean, not pricing that’s not. I guess if there are any struggles or functionality or systems issues or anything that you tend to have some hiccups with that I should just things that I should expect and be prepared to kind of navigate through so that it’s not a surprise.
Mallory Smith (32:46) Like you.
Robin Redd (32:47) Know, there’s no company. I don’t think you know, everyone I would think would be always doing like continuous evaluation and continuous improvement in some fashion. So what are, you know, what are the, I guess pain points for you? And what are you, what do you work on right now to kind of improve? I guess the functionality or the process flow or things like that. That I… would just need to be aware of?
Erica Lloyd (33:21) Yeah. I mean, what I would say is I’m glad you’re asking that question because it’s like obviously showing being pragmatic on the decision. I think there’s a lot.
Robin Redd (33:32) We.
Erica Lloyd (33:32) only kind of know what we know at this level at the executive level, they’re always doing something and they have access, you know, we’re in our silent bucket. So.
Robin Redd (33:43) It’s.
Erica Lloyd (33:44) almost a challenging question. Without the context of it. I think like every single company in the world, we are still trying to figure out how do we integrate more and more automation? Like how do we go fast? How do we provide access to more customers faster? Cheaper better? I think that’s probably the plight of everyone and that’s kind of always the rally cry when we get together but at the executive lens.
Robin Redd (34:10) There’s.
Erica Lloyd (34:11) always something going on.
Robin Redd (34:13) Go ahead, Mallory. I’m, sorry.
Mallory Smith (34:18) Sorry, I’ll just say really quickly, ncqa credentialing is kind of our bread and butter. We’re fully comprehensive. You know, we do standard enrollment. We’ll do delegation. We’ll do privileging hospital applications. There’s areas within those components that I’m just like, well, yeah like portal automation is something we’re working right now with like hospital apps. We have it figured out for pay or enrollment. We’re working with it for hospital applications. So there’s areas in each of those that I think could use. Some. We, of course, are still working on those. I see updates coming through for those regularly. But when you think of ncqa, caqh is a direct import but just caqh id, caqh has 100 percent of the ncqa elements that we need. 90 percent of it’s. Automated ncqa requires human intervention to review the files. So it’s just like a standard by the accrediting body. So that’s something we can’t necessarily automate, we have to have our team review it. But then we’re still meeting the three day SLA with spring health. They had a very quick turnaround time. So I do actually have a question for you. When we partnered with them. They needed 1,200 credentialing files done within a month and we beat the time. So, I think this is the one area in the platform that we’ve been doing this for six years and we’ve maintained the certification and I think this is what we have to show for it. We’ve automated as much of it as we can. The question I have for you, the 2,500 providers in the network, is there a growth strategy there, or are you bringing in what’s the expected growth?
Robin Redd (35:54) So, I don’t know that they’ve outlined a growth strategy. My feeling is that because our team is going to be new to building a network that… I’ll just say the experience with like our contracting group has up till now been re contracting.
Robin Redd (36:14) So in terms of we already had a list, we’re re contracting for whatever reason, the, you know, the relationship with our customer is that they need to be directly contracted with us. Now, again that’s for different lines of business. So don’t read too much into that, but this would be the first time that we would have a team that has to do more than just re, contract. And I think there’ll be a little learning curve and I think they don’t quite know yet what that looks like in terms of recruitment, you know, going out and finding a provider, selling them on the idea of joining your network, negotiating through the compensation. All of that takes time and it doesn’t all happen on the same day. So while I’m aware of that, I don’t know what the timeline looks like. So in my process that’s a question mark right now, it’s a TBD because I don’t know how long that team would need to get that piece done. So, my guess is that while… probably a large number of those would hit in the first like 30 days, they’ll probably still be some trickling. And I mean, I’ve… kind of, I mean, my direct supervisor, Amanda and I have had enough experience with this that we’re like just… off the cuff, tell this, you know, tell our CEO, tell our coo that we need six months. Just tell them we need six months and that gives us a place to start so that they know it’s not two months or three months, you know, like I’m just saying like that’s why I’m telling them like we need 30 days for committee, we need 90 days for the cvo, we need, I’m just maxing out as much of that process timeline kind of in an old school, but within ncqa. So I’m building in as much extra time as possible because there are some unknowns now the contract management piece that, you know, that director may say I can do that in 60 days. And I’m gonna say that’s fantastic. But I’m also gonna know that he’s probably gonna dip into my timeline because that’s probably not. I mean, it’s probably not realistic to have 2,500 providers contracted or, you know, find them or, you know, convince them that you’re the game in town and do everything you need to do within 60 days. So, I don’t know that I’m answering your question, but I guess, I think I have a fairly realistic view of what that looks like. I think it will be a single state. I think it will be behavioral health out of the gate and I think there’ll be different types of providers. I don’t know how hard that recruiting effort will be because that’s a little out of my Lane. I’ve built specialty networks before it’s been some years. And I know that, you know, fee schedules were always sticking points. Sometimes it took some time to, you know, to get through that process. So… I would say that probably trickling over, I would say a 60 to 90 day period is more realistic. I mean probably the majority sitting somewhere in the middle. I would imagine that some of them will fall in pretty easily. And then, you know, there’ll be some momentum in the center and then there’ll be some stragglers hitting. So that’s my guess, you actually may know that better than I do.
Mallory Smith (40:00) Oh, gosh. No, probably not. I think if we can absolutely work with any timeline, we of course, have to make sure we have the right staffing resources, but.
Robin Redd (40:11) I.
Mallory Smith (40:12) think realistically over the first two to three months, having it completed in the first six months, I’ve seen that done before. I’m sure we could do it again. I think that’s a reasonable timeline especially with so many factors outside of your control when it comes to engagement provider recruitment and the fee schedules.
Robin Redd (40:33) Yeah. And I do think again because… I think it’ll be a little bit of a it’ll either be some expansion and growth for an existing department or they’ll be pulling some new people in. I think they will probably a little underestimate the effort that’s going to be needed because I think they’re so used to recontracting and there’s really no convincing involved there like the providers already know, you’re going to it’s they just, you just have to get them to sign it. It’s just more of a compliance than anything else. So, while they have done massive numbers within a like a 30 day period of a recontracting effort, it’s different.
Mallory Smith (41:14) Right? It’s different. Are you loud and clear, so.
Robin Redd (41:19) I’m just smiling and sharing.
Mallory Smith (41:24) Okay, perfect. No, I appreciate the insight there. And I know you’d also ask about the ongoing monitoring. So we are in cqa complying with that. I did want to share the document I had created a few months back just to kind of give you a visual on what that would look like. So of course, it’s stored in the platform under monitoring. So we spent most of our time today on providers and credentialing. And then if you go to monitoring, then we zoom in a little bit… you’ll see if something does pull back from the provider, there is an issue, it was captured automatically. It’s related to the Dea license. You can then view the verification evidence, and then it’s going to show you what exactly happened. It needed attention. Where did it occur? What’s the preview? What are the details as a part of that? So I did put that together. Where that is stored in the platform is right here under monitoring. So you’d basically see all 2,500 providers here. You can go through and filter based on the checks, if it’s a status, if it’s flagged, if it’s clean. So it’s going to be a very similar view to credentialing. So, I know you’d mentioned ogm yesterday. I just want to give you that visual as well.
Robin Redd (42:39) So if something, if there’s a hit there, Do you, and you may have already told me this? So I apologize if you did okay.
Mallory Smith (42:47) Do you?
Robin Redd (42:48) Do you research that to make sure that it is in fact that person it’s not? Do you like verify the social or verify the death master? I mean, do you, what all, do you do to make sure that what’s being reported is actually for the right provider?
Mallory Smith (43:04) Great call, great call. So, I know like with Sam for instance, you have to check the names because there’s so many. My husband’s name is James smith. I guess his parents hated him. I think that’s a great example, right? Yeah, every time he has to go for a background check, it’s a nightmare. But, yeah, what it would do is immediately flag the system. The provider would then get an automatic notification. Your team would then get an automatic notification. So we’re not making any decisions for your team. What we are doing is flagging it in the system so that you can then see exactly what’s happening when it comes to verifying it is the correct provider. Yes, our team will do the due diligence there and ensure that it came back on the oig, it came back on the Sam. So we’ll make sure it’s matching. But part of the integration behind the scene is we have those direct integrations with npez npi registry, for instance. So if the provider uploads their caqh, it’s going to verify the npi, the taxonomy, the primary address and the way to contact them is correct and lined up with what the npi registry does. So, we have similar tools for that whenever it comes to ongoing monitoring, okay?
Robin Redd (44:14) Sounds good. All right. Perfect. I can.
Mallory Smith (44:16) Stop sharing now, but I can send you that visual of that workflow just as a leave behind. I can send you that document when it comes to tracking the ongoing.
Robin Redd (44:25) That sounds good. So I’m seeing report builder on that.
Mallory Smith (44:29) Oh, yeah. That’s right? I really love the report builder. What?
Robin Redd (44:35) Is the roster generation or what does that look like?
Mallory Smith (44:41) Sure. So with the saved reports, big benefit for you here is that your team, we’re going to send you a standard canned report that you can use. It can be for onboarding, credentialing, pay or moment. You also have the ability of creating your own. So this is where the roster generation comes into play as well. So with report builder, you would just let us or your team would be responsible of saying what type of reports you want. One. Just for provider directory, you’re going to have every data point that we track at the provider level available in the order that you select them that’s the report it’s going to build. So I could say last name, first name, let’s go with maybe… where they’re at their npi… if they’re their date of birth, just anything that you would typically see from a payer or a directory, need profile, completion, state, caqh, numbers, start date, term, date, all of these just random fields, transition it to the right. You now have a report with that information. You can filter within any of these. You can export as an ad hoc. You can also save it so that this report can be sent to anyone on your distribution list as often as possible. So.
Robin Redd (46:01) If they have like, if the payer has a particular format for the directory, can we just export the data into like an excel and then move it in?
Mallory Smith (46:10) Absolutely.
Robin Redd (46:12) Oh, sorry. I imagine that they still try to make that a little difficult just dealing with one of our, I mean we have a blues customer. So I know that they’re… particular, everything has to be, yes, blues.
Mallory Smith (46:25) Are particular happily.
Robin Redd (46:28) Particular, we like to be burger king, but is… there any kind of training that’s necessary for like my internal staff to use the system? Is it, how does that work? Good question?
Mallory Smith (46:48) Really, the training is minimal. It’s going to be more about where you can find each of the aspects in the system because our team is performing the actual services. So what the training is a part of the implementation timeline? We would meet with you weekly so that your team is comfortable, they’re familiar. They’re aware of the access that they each individually have. But when it comes to training, essentially you’re going to have your team go to their providers. So the provider tab invite the new providers, whether that’s in bulk or an individual, they’ll come to credentialing, they’ll review the files that are ready for committee to see what’s been closed approved, rejected. They can run their own analytics if they want to. So if I look at credentialing analytics, and then of course, the report builder. So it’s not training per SE.
Robin Redd (47:38) Yeah, nice.
Mallory Smith (47:40) Demo environment. But you are able to see credential files generated, approved credentials, historical performance, and all of this is just standard within the platform.
Robin Redd (47:50) So what does the implementation timeline look like?
Mallory Smith (47:54) Yeah. I’ll go ahead and stop sharing implementation. So that’s going to be unique for you when we have a customer that comes on. And they say that we already have 500,000 providers, their information is stored in caqh. Then we would quote eight to 12 weeks just to get them data migrated over. So you have a central source of truth, you’re able to train the staff, you’re able to make sure everything is working. Sops are verified. If in your situation where you don’t necessarily have any providers to implement, at the get go right now, then the implementation would basically just be your group and facility information. If you have any of that, from there, we would teach you how to bulk import your providers.
Mallory Smith (48:37) Caqh is going to bring over 75 percent of that already. There’s not much to implement. So right now, Erica tell Sammy Sammy’s our head of technical solutions. I’m never allowed to quote the less than eight weeks for, you know, give them a buffer, but.
Robin Redd (48:53) I see.
Mallory Smith (48:54) A really quick implementation just because you don’t have any confirmed providers yet. If that makes sense. So we would do the group stuff. And then basically as the providers are onboarding.
Robin Redd (49:05) And that’s so that’s kind of part of again, the reason that I stuck with the 90 day PSV timeline is because, you know, that additional time might really just be front end set up. I did build in another 30 days for just like getting an agreement in place with the cvo. But so basically, I’ve kind of allowed 120 days for setting up and getting committee ready, and then another 30 days for committee. And then, so I’ve tried to stretch that as long as I could just because there were so many unknowns. So it seems doable based on what you just said. I mean, if there’s like a, you know, 12 to 16 week implementation timeline just because of backlog or lead time needed on your end or whatever to get going, you know, that’s significant because that would no matter how fast you could do on what you had on it, would, you know that needs to be factored in. So that’s good to know.
Mallory Smith (50:17) Absolutely. No. I appreciate the questions today and I’ll have those as a fast follow. But Erica, is there anything that you need as far as next steps? Yeah.
Erica Lloyd (50:26) Thanks so much. Thanks for that. I know we’re over time here. So I want to be talking to that. Thanks so much for, the demo. Mal. I think what we can do then is a, as a next step since we have the time for tomorrow is, do we have everything we need for the scoping?
Robin Redd (50:47) Here we do. Okay.
Mallory Smith (50:48) I’m gonna quote for 2,500 providers for ncqa, cred, ongoing monitoring in year three. We’ll consider re, credentialing, but yeah, we’re good all.
Robin Redd (50:58) Right. I’m gonna share, yeah, if that would be great. And if you can kind of help me help myself with kind of the maybe the three year cost profile, just like, I know year one and year three are big initial and re, credentialing, but what is like, how does year two look in comparison? Like if there are things that are, because I don’t want to discount that, I don’t want to, I don’t want to forget to consider what year two looks like. You know, financially speaking, that would be a big misstep with my CFO. He’d be like what thought it was just year one and year three? So, yeah.
Erica Lloyd (51:39) So we’ll.
Mallory Smith (51:39) we’ll be.
Erica Lloyd (51:40) prepared to do that to walk through that tomorrow then? Fantastic.
Robin Redd (51:45) Yeah.
Erica Lloyd (51:46) We can also say.
Robin Redd (51:47) Like usually helpful, good.
Erica Lloyd (51:50) Good, but glad it was helpful. We can also just, I’ll just compare, like if you were to build just so your CFO can see that’s how much it will cost.
Robin Redd (51:58) That’d be great. Thank you guys. I appreciate, your expertise, your feedback. And, you know, as I said, I’m a little rusty in this world. I haven’t been doing this recently, so some of my information may be dated. So I’m certainly open to, you know, gently bringing me into the present. So I appreciate your patience, no.
Mallory Smith (52:23) We appreciate the time. Thank.
Robin Redd (52:25) You so much. You guys have a great day. I look forward to talking to you tomorrow. Thanks.
Mallory Smith (52:29) For having me. Thank.
Robin Redd (52:30) You.