Transcript
Neil Brennan (00:00) hi, how are you?
Fatima Nunes (00:02) I’m doing well. How are you? How’s your Tuesday going?
Neil Brennan (00:06) So far? So good.
Fatima Nunes (00:08) Good, good. And I see you’re in the office. Do you remind me again, do you go into the office every day or is it just a few times a week?
Neil Brennan (00:15) Monday, Tuesday, Wednesday, and I’m in office here in Orlando. And then Thursday Friday is when I’m out.
Fatima Nunes (00:21) Okay. That’s not too bad. It gives you Thursday, Friday to kind of a long weekend. Awesome. Hey Scott.
Scott Call (00:28) Hey, can you hear me okay?
Fatima Nunes (00:30) We can hear you. Can you hear us all right? I’ve.
Scott Call (00:32) had, yes, you’re fine. I’ve had some sound issues today, so, apologies about that, but nice to be with you again. Hi, Dave Scott.
Dave Wallach (00:41) Nice to meet you, Neil as well.
Scott Call (00:43) Hello? Thank you. Yeah.
Fatima Nunes (00:45) Nice to meet you guys again as well, right? I see you just met Dave. I think we talked briefly about him last Friday, but he leads one of our enterprise sales teams here out of the northeast, so I’ll give him the opportunity to introduce himself shortly. But really, I know we have the next 30 minutes blocked off for our call. Does that still work for the both of you? It does okay, great. And so, I know Dave, I’ll give you the opportunity to just better introduce yourself. He’s been itching to meet you both. Well.
Dave Wallach (01:18) Thanks Fatima, Neil. Scott. Great to meet you. I’ve heard great things about both of you from the conversations as Fatima mentioned. I’m in New Jersey. I’ve been with medallion for almost two and a half years now, and I lead as she said, one of our sales teams and just happy to be here and hopefully contribute in some sort of positive way and be part of the conversation. So, looking forward to it.
Scott Call (01:41) Sounds great. They’ve done a good job so far, Dave. So I don’t know if either of them report to you, but they’ve done a really good job.
Dave Wallach (01:49) Their personality.
Fatima Nunes (01:51) I didn’t pay Scott to say that.
Dave Wallach (01:53) I was going to say their personality only gets them so far. So, wow. Wow.
Neil Brennan (01:58) Way to keep us.
Scott Call (01:59) Humble.
Fatima Nunes (02:01) well, with that, I’ll just transition over to sharing my screen. But really, you know, we’ve had some great conversations. I think the goal for today is pretty straightforward, give you everything that you need to decide if medallion is the right fit for new season or not, right? I feel, I think both Mallory and I feel very confident that we are going to be the right fit for new season. But what matters most is that you walk away feeling that way. So from an agenda perspective, before I share my screen, we’re going to briefly recap your current state, what future state would look like with medallion, walk through the business value. A few of these slides are going to be repetitive just from last week’s call. We’ve made some minor edits based on your feedback. But then really the bulk of the conversation we want it to be around the business value as well as reviewing the pricing proposals which we put a few based off the different options we discussed. But does that sound like a good use of time?
Scott Call (02:52) That’s perfect. Yeah, matt.
Fatima Nunes (02:55) Okay, great. I’m going to go ahead, share my screen here. Okay. Can everybody see should see agenda? Yes, we got you. All right. Perfect. So I thought it would be helpful to highlight the main theme of the discussion. If you take one thing away from this call, it’s that by partnering with medallion, new season will accelerate roughly 10 to 15,000,000 in annual revenue and get your providers and network 90 to 147 days faster. And we’ll review the breakdown of those numbers and how we got there in the next few slides… I’ll pull ahead here. So from all of our conversations with both you Scott Neil, four things really stood out as most critical in your evaluation. One slow credentialing is delaying revenue and limiting growth for the business leadership wants faster speed to build with greater operational control, which is why delegated credentialing is a business priority for 20 26 and last, but certainly not least, right? You have a bit of a fragmented process right now across different vendors which is increasing the operational workload for Neil, his team and overall just limiting visibility into this process today. So those are some of the challenges that you’re trying to solve for in 20 26. And I’m just going to keep pulling ahead if there’s anything a very.
Dave Wallach (04:19) quick question. If you don’t mind just to go back to the number three round delegated credentialing Scott, Neil, I’m just curious. Have you explored delegation prior to the conversations that you’ve been having with Fatima and Mallory or last month or so? Like in the past as an organization? Have you explored it?
Scott Call (04:39) Go ahead, Neil? Well.
Neil Brennan (04:40) I just joined the organization back in June of last year. So I haven’t been here a year yet, but it’s been spoken about in meetings since I joined, but I don’t know the history of it. Scott’s, only been here since what? December of 24. Yeah.
Scott Call (04:58) You’re good that you knew that month. Even I’m surprised Neil, you had that, but, yeah, Dave. So it’s been kicked around, right? We’ve talked about it for a long time. We just haven’t been at the, you know, in the right place until now to be able to kind of move forward with that.
Scott Call (05:13) And so we’re absolutely doing it this year, which is why, you know, we’ve gotten very serious about working with, you know, getting different bids and talking with different vendors. So, yeah, we’re absolutely moving forward but not seriously until now. Okay?
Dave Wallach (05:31) Great. I appreciate that. And then my last, is it coming from the C level or is it coming from the boardroom conversation? Like where’s the direction coming from?
Scott Call (05:41) Yeah, certainly. They’re supportive and both from us and from them is really where it’s being driven? Yeah, perfect. Appreciate it. They’re very supportive. Yeah.
Fatima Nunes (05:52) Thanks, Dave. So let’s pull ahead here, right? When we think about how medallion will solve for some of the points that we just reviewed, right? And how we’re going to help you achieve those in 20 26, first, right? We’re the only vendor in the space who contractually commits to turnaround times in our agreements. You don’t have to take our words for it that we’re faster, better, stronger than anybody else. If medallion misses on these slas, there are financial penalties on us. So we are held accountable. Second, our technology automates about 80 percent of the manual work involved in these processes today, which allows you to scale down resources as you continue to grow. So as the business grows, the technology is going to grow with you. So you’re not worried about Neil’s not worried about hiring training new staff or dealing with turnover and all of that. And then third, right? We do it all, every service you’re currently managing and outsourcing today, lives in the medallion platform. We’ll help you consolidate vendors, give you full visibility into all of your provider, your facility data. So really thinking about us as a one stop shop. And then fourth. And I know this was something that we talked about Friday is medallion is the only vendor with a bi directional caqh integration. And what this means, right? Is that we can push and pull data into caqh and manage those quarterly attestations on behalf of all of your providers, which of course, is going to result in huge time savings and just more accurate data as you submit those enrollments and those credentialing files. So just overall less errors there. I’ll pause there, right? I think when I think back to our conversation on Friday, Neil Scott, you both mentioned the vendors that you’re looking at, they were pretty much all in line. So I took that as a homework assignment and wanted to create this slide around, you know, kind of our biggest differentiators as you’re looking at all these different vendors. So would love to get your thoughts, right? How do these capabilities stack up against what you’re hearing from all of those vendors?
Scott Call (07:52) You want to take that Neil?
Neil Brennan (07:54) Yeah. I mean, I think number one and number four on this slide are definitely something that we see that medallion offers if the other ones do not. When, I think when I was talking on Friday about, I meant the demos that we saw for the platform itself seemed to be very comparable as far as like navigation and being intuitive and drill down and running reports and generating a roster and all those types of things those types of things seem to be in.
Fatima Nunes (08:27) Different.
Neil Brennan (08:28) Places, but the same thing over and over.
Scott Call (08:32) Okay. Fatima, quick question on number four there. Why is that the case? You know, why is medallion the only one that has that bidirectional? Is it the way the apis are built? Or why do other vendors not have that capability? Do you know?
Fatima Nunes (08:48) Our most common question, I see Mallory came off mute. So I’ll let Mallory take that.
Scott Call (08:51) One go, Mallory Scott.
Mallory Smith (08:54) This is one of my favorite questions. I love this, like Fatima would never take this away from me. So how this works is our CEO, a few years back went to caqh and they said, hey, here is my mission and vision for what we want to see in this industry. Caqh is already a shared repository for 90 percent of the hospitals and health care systems as well as 90 percent of the payers that use caqh. So, our CEO, Derek presented it to caqh and their executive team. They loved the idea so much that they agreed to enter into a exclusive partnership. So we’re known as a participating organization. So we have the same access to caqh. Like the payers do. That’s why we only need their caqh id. We don’t need the provider’s username and password.
Fatima Nunes (09:37) So, I love.
Mallory Smith (09:39) that story because caqh loved the idea of medallion so much. They’re just like this is not a partnership we would pursue with anyone else just because they’ve been in the industry for so long, but that’s how we’ve been able to keep that relationship for years now.
Scott Call (09:56) All right. That’s great. That is a big deal for us because it reduces the amount of work on our site, right? That we have to do to update all those profiles in caqh. So that’s important absolutely.
Mallory Smith (10:08) And it’s fully automated. It. Just if you make a change in the medallion platform, it’s automatically pushed back to caqh. It reattests on behalf of the provider. So the providers only have to log in to caqh one time a year and basically say, yep this information is still correct, it really reduces the time that you need there.
Fatima Nunes (10:26) Right. So just streamlining all of that data. Okay? So I’ll go ahead here and you’ve seen this slide before, it’s just wanted to leave it here as a reference. It’s our slas that we contractually commit to. I’ll go ahead here. We also covered this slide on Friday’s call. I’ve kept it to illustrate really where you’re at today versus where you could be with medallion high level turnaround times. You’ll have an ncqa ready credentialing file in just one day.
Fatima Nunes (10:54) Direct enrollments are going to drop from 150 days down to 60 days if you move forward with like the payroll enrollment support. And then on the resourcing front, we’re going to cover these points in more detail in the following slides. Okay. So I did want to make this tangible with a customer story here. I think it’ll hit close to home based off where new season is. Right now, a family care center came to us about three years ago. They had five clinics, 120 providers, two credentialing specialists in house and zero delegated agreements. Today. They’re sitting at 45 clinics, 650 plus providers and delegated with most of their major payers. And they’re still running with those same two credentialing specialists that they’ve had. And so what really makes I feel this story, the most relevant to you is that they were starting from scratch on delegation, no experience on it. Just kind of similar situation where you and Neil are at right now and medallion helped them build that foundation and it’s what’s really unlocked their ability to scale fast and get those providers billable in days not months. So, I did just want to highlight this before I keep going. I want to make sure that we’re aligned and that this is resonating.
Scott Call (12:05) Yeah. How long have they been under contract with you?
Fatima Nunes (12:09) Three years. Okay. That’s great. Yeah. Okay. Great. Neil. Any questions on that? Good? Nope. Okay, perfect. So, right. So let’s dig into the business value assessment. Really the two major components here. It’s going to be the revenue acceleration and then opex reduction and what that’s going to look like for new season with medallion. And I just realized I didn’t remove all the animations here from last week. So I’ll just jump to the chase here. So we reviewed all of this, right? This is the revenue impact specifically on your direct enrollments. If you were to partner with medallion, we covered the methodology on Friday. The one change we made based on your feedback was adjusting the daily revenue per provider to better reflect your actual mix. So we heard you loud and clear 30 percent are MDS and ndos that they build, you know, 1,500 a day, 70 percent are really mid levels at roughly 500. So that blends out to 800 dollars on average per day. And so that brought the number down significantly 40 percent from our first pass. But you can see and I think we talked about this, right? Even with that more conservative assumption, you’re still looking at 10,000,000 in accelerated revenue in year one alone just simply from getting those providers to par status 98 days sooner. So I’ll pause here.
Scott Call (13:29) Provided I can get them under contract that’s the kicker, right?
Fatima Nunes (13:32) Right. Exactly, right? So, how does this math look now that we’ve refined it scaled it back more?
Neil Brennan (13:43) More realistic, I think. Yeah.
Scott Call (13:45) I think that’s closer for sure. Okay? Perfect.
Fatima Nunes (13:49) Yeah. And the goal, right? If we’re fortunate and we continue partnering and we have follow up conversations. It’s let’s continue refining this before it gets to Jonathan and the broader team. And then here, this is same exact math methodology. But now we’re talking about delegated credentialing, right? With delegation in place instead of those 60 days to credential we’re down to three days. So against the current 150 day baseline that’s 140 days, 147 days faster. And then ran that same math, 130 providers times, 140 days fast, sooner, 800 per day and you’re looking at roughly 15,000,000 in accelerated revenue annually. All right?
Scott Call (14:29) Neil, it’s okay. If you haven’t had the chance to do this because I know you’ve been out but you haven’t asked revcycle about these dollar figures per day by chance, have you, I was hoping, I was hoping I would remember to talk with them about it in our meeting this afternoon, but I forgot, so.
Neil Brennan (14:47) No, I have not, but that’s about appropriate, I would think.
Fatima Nunes (14:52) So, what else? What else? Yeah, go ahead, Scott? Oh, no, no.
Scott Call (14:56) I was just going to say I’d like the opportunity to do that. Just, it has no bearing whatsoever on our decision. I just, yeah, would love like you said, Fatima, I’d love to refine these before we take this presentation offline.
Scott Call (15:08) Just so we have accurate data here. Yeah… that’s on us that’s not on you that’s on us. So, yeah, because.
Neil Brennan (15:19) We met, we met with y’all on, you know, Friday afternoon. And then I was, I actually had off yesterday because I was traveling for Easter weekend, I traveled just to go see my family. So I have not had a chance since Friday afternoon to talk to RCM about.
Fatima Nunes (15:32) That. And you didn’t work on this on your pto, Neil?
Scott Call (15:37) No, come on, Neil. Come on.
Fatima Nunes (15:40) Neil, you didn’t work on it on Easter morning?
Scott Call (15:43) No, no.
Fatima Nunes (15:45) No, I was.
Neil Brennan (15:46) I was hiding Easter eggs, for my nieces on Easter morning. So, no.
Fatima Nunes (15:53) I think we’re all on the same page there. Yeah, Dave, go ahead.
Dave Wallach (15:56) Yeah, I had a quick comment and then a question. I couldn’t get off mute sooner soon enough. Quick enough. Two slides ago. Family care center. I recently met matt at an event. I’m sure he’d be more than happy to have a conversation with you guys, as a, you know, if you wanted to, if you think we’re the right, right, right vendor, we can reach out and see if he’s open to a conversation.
Dave Wallach (16:18) Thank you. Appreciate that. That’s that’s one. And then the question I had is sorry… Mel, I’m looking at what your message had just popped up? Oh,
Mallory Smith (16:27) it’s not relevant at all.
Dave Wallach (16:29) Okay. Sorry, I’m looking at the slide and it just popped right in front of me.
Scott Call (16:35) What if you?
Dave Wallach (16:36) Presented numbers like these and they were fine tuned. I mean, is this how you and the rest of the leadership team would perceive an Roi internally in terms of revenue acceleration? Is this tangible information that would you buy in the rest of the leadership team would buy into? Mel? I see you shaking your head. Yeah, I.
Neil Brennan (16:57) didn’t know Scott was going to speak, but, yeah, these two slides will be very helpful when going back to the C suite with estimates and why we think why we feel one way about a vendor compared to another vendor and about delegated in general. Great. Perfect.
Fatima Nunes (17:20) So, these slides are copyrighted. So you can only use it if you move forward with medallion, if not, I don’t give you permission to use it with any other vendor.
Scott Call (17:29) I’m just.
Fatima Nunes (17:29) joking. But what I was going to add, Scott, I shared the editable version of this PDF with both you and Neil on Friday. I’ll send you this updated one. And that way once you have those refined numbers from revcycle, then you could just pop them in here just to make it easier.
Scott Call (17:45) Perfect. All right. Let’s.
Fatima Nunes (17:47) move ahead here. How are we on time? We’re good. Okay. So that’s on the revenue front, right?
Fatima Nunes (17:53) The other place where we would see significant impact it’s on the operating costs. So, our team did a pretty comprehensive analysis. This is something that we do for almost every organization that we partner with, where we go through your actual volumes and scope of work to figure out what staffing really needs to look like. If medallion was doing all of this work for you. And what we found is that you’d go from the five in house ftes that you have today down to one and a half, right? And I know we can kind of break it down the way we thought about that was or the way the Mallory you can jump in, but one and a half ftes would be one full time and a part time fte. The data showed one full time fte for payr enrollment to manage those requests in the platform. And then about a part time fte to manage the credentialing requests in the medallion platform. And so, I know today, right? When you put a dollar figure on that you’re currently spending around 400 K in salary and benefits. And then with medallion that would drop by 320, right? And that’s just, from the reduction in opex. Yeah, Mel, I’ll let you go. Thanks.
Mallory Smith (19:01) I just like to explain some of the math behind how we achieve these numbers. So our analytics team basically performed two different types of case studies. The first one that they did was they get a handful of our customers and they basically said how long is it currently taking your team to complete payr enrollment applications? They took the aggregate of that, averaged it out, found a good median among that. So they did the onboarding, payr, enrollment, credentialing to ncqa ongoing monitoring, all of the different elements and products that you’re looking at with medallium. They then came internally and then talked with our team who currently uses the medallium platform and we were able to leverage and see how it compares. So when they measure the time on how long it took our team to complete the cred files, submit the enrollments follow up on them and so forth. So we have an allocation calculator that we use internally that I was able to take the volume of SKUs that you have, whether it’s for the enrollments. We did the comprehensive ones. So enrollment, ncqa delegation, ongoing monitoring, onboarding, and so forth. And that’s how we were able to deduce down to about one point five. We’re thinking about one of those resources for payer enrollment. So tracking all the different applications you have to submit for individual as well as facility. And then about half an fte just to manage the credentialing is much Symplr. It’s 90 percent automated. So basically that half an fte would be responsible for requesting credentialing files and then ensuring that the committee has been able to review them and that they have been logged in the platform. There’s no issues that arise. Any questions with just the math behind the scenes… not from them? Great. Okay. Thank you. Well, if any.
Fatima Nunes (20:44) Questions come up after the presentation today, we can do a separate session around those numbers. All right. And I know revenue leakage is something you’ll need to loop in revcycle for we won’t go too deep here. But I did want to keep it in here because it is a real part of the value story and worth having that broader conversation down the road. So we can populate this once we’re further down.
Mallory Smith (21:10) Right.
Fatima Nunes (21:13) Okay. So when we bring everything together, the 10 to 15,000,000 in accelerated revenue annually, 320 K back in opex and the revenue leakage piece still to be determined.
Fatima Nunes (21:24) You’re looking roughly at about 10 point 3,000,000 plus in realized value in year one. And we feel confident that’s a conservative number.
Mallory Smith (21:35) But of course.
Fatima Nunes (21:36) We would partner with you closely and continue to refine this data to make sure it aligns with what you’re seeing internally. I’ll pause here, you know, any thoughts on the business value on the last few slides that we’ve gone through?
Scott Call (21:53) Other than again, I’ll say tongue in cheek, you know, that is provided we can get all those contracts in place. So I don’t know yet, you know, when we start into all that, how responsive the payers are going to be. Hopefully they’re fairly open and we can just roll, but yeah, would… love to get to that point this year.
Mallory Smith (22:18) Absolutely.
Fatima Nunes (22:20) One thing that.
Neil Brennan (22:20) caught my eye about the slide is it looks like the symbol for medallion. It looks like two fidget spinners that have been placed like the star of David.
Dave Wallach (22:33) You’re the only person that ever got that right? That’s what Derek’s goal was when he designed it.
Scott Call (22:38) I’m joking.
Fatima Nunes (22:39) I think our CEO would fall backwards if he thought that’s what people thought about at this time. Okay, good. And I wonder, and, you know, Mallory and I can maybe there’s data around that Scott right around depending on the payers that you’re working with. What we’ve seen internally with some of our other customers and we can have that conversation down the road to make this even more realistic. I mean, we have 400 customers working with us today. There’s a lot of data that we can gather to help strengthen this. Okay. Yeah, I’d love.
Scott Call (23:11) To send you our top, you know, 20 25 and just have you break that down although we might, I don’t know, we probably need to have an NDA in place or something to do that. But, yeah, I’d love you to take a look at that.
Fatima Nunes (23:23) Absolutely. Okay. So let’s transition. I know we’re running short on time but let’s transition over to the proposals. So this is everything we reviewed on Friday. We validated all the scope of work, the volumes, everything year over year. These are all the quantities they’re here for you to reference. I’ll pull ahead here. So we put together three options because we wanted to give you the flexibility depending on where you want to start. What makes the most sense? Option one is built around your immediate need, which is credentialing delegation support, caqh management. And that’s the core problem that we’ve been talking about solving. Options two and three are really just what if scenarios, what would it look like if you decided to consolidate and move away from one or both of your current vendors and bring those services to medallion instead. So just want to give you a couple of ideas there. And I’ll pull ahead here. So we’re going to start off with we’re going to go in order, right? We’ll start off with option one, which is going to be all of the ncqa credentialing ongoing monitoring, the full delegation support. And then the caqh management for all 200 providers. So for option one, on a three year term, you’re looking at an average annual cost of 83,765 dollars. Like I mentioned, it covers full ncqa credentialing, ongoing monitoring delegation support. And then the caqh management of all those 200 providers. The year over year breakdown is outlined right below that. Year one comes in higher at 97,792. And that’s because of a one time implementation fee plus the initial credentialing of all those 200 providers, years two years three, the cost drops to 76 K because the implementation fee falls off. And then you’re only credentialing approximately 130 new providers that you’re adding annually. And if you remember, we talked a little bit about that last week, right? Just year one, you’d have to have credentialed all 200. And then in the out years, it would just be the new providers, I’ll pause here would love to get your thoughts around the price, right? Does this feel aligned with the value you’re expecting and some of like the budget goals that you had in mind?
Scott Call (25:34) Scott always?
Fatima Nunes (25:35) Gives Neil the hard question.
Neil Brennan (25:37) Yeah, I know. Yeah, he always picks on me but then it doesn’t really matter what I say because at the end of the day, it’s the woman that has to go pitch it to the C suite. Well, I mean, I guess both of us together but they’re going to listen to him more than it.
Scott Call (25:52) Always matters. What you think, Neil, it always matters.
Neil Brennan (25:56) Yeah. I mean, I guess with the combination, I mean, this seems about the appropriate amount if you were doing all three of those things at the top but I guess what I’m a little bit concerned about is like before just standing up, you know, delegated and get it, rolling it out over the course of a year and us having, you know, initially possibly only three or four payers that allow us to even do delegated in the first, you know, 12 months of rolling this out.
Neil Brennan (26:25) I wonder if, you know, when it has listed here, credentialing delegations, boardings, aqh management are all three of those just speaking?
Scott Call (26:34) Of.
Neil Brennan (26:35) delegated credentialing on its own. And option two and three were like, I saw, option two was adding facility credit. And option three was just that. But is this option one just delegated credentialing or is that part where it says credentialing, comma, are you talking about also replacing our current vendor to do provider enrollment?
Fatima Nunes (26:56) Exactly. So if we go back to the options, we would be, so option two, we would be replacing your facility enrollment credentialing vendor, and then option three, we would replacing both the payer enrollment and then the facility credentialing vendor. And then we would of course, be handling delegated credentialing.
Neil Brennan (27:13) Okay, great. So option one is just speaking about delegated credentialing, right? And then.
Fatima Nunes (27:18) Every option. So option two is just going to build off of this on top of this, all of this plus the facility, but this is really at the core, right? This is the reason why you came to medallion. This would solve that initial delegated credentialing support the ncqa credentialing files and then caqh management.
Neil Brennan (27:38) Got it. Thanks. So sorry.
Scott Call (27:40) To clarify for me, sorry if I just missed you say, this does also, I’m just reiterating making sure I understand this does include our provider enrollment outside of delegate or does not.
Fatima Nunes (27:53) It does not.
Scott Call (27:54) Does not. Okay. I just want to make sure I heard that correctly.
Neil Brennan (27:57) This is the credentialing in the caq management regarding the ones that they’re going to put in their system to do the delegated credentialing.
Scott Call (28:05) so then it,
Neil Brennan (28:06) would be the maintenance, the caqh maintenance and all that for the providers that were included for that.
Scott Call (28:14) Okay. It would be really nice to see that provider enrollment breakout as well.
Fatima Nunes (28:22) It would be.
Scott Call (28:22) Helpful for comparative reasons. So.
Fatima Nunes (28:26) Absolutely. Well, I read your mind and we put it in option three actually has that breakdown Scott of what it well, not the breakdown but it has what the all in cost would look like. And of course, we can give you a detailed breakdown of that.
Scott Call (28:35) Okay. And I know.
Fatima Nunes (28:37) We have one minute left. Are we okay to go five minutes over just to finish out the two other options for?
Neil Brennan (28:42) Me? Sure. Yeah, yeah. And.
Scott Call (28:44) Then also Fatima, I’m sorry, what I’d also love to see what I was telling Neil earlier today. Chances… we’ve had as we’ve told you, we’ve had a really bad experience with a vendor a year ago that we terminated?
Neil Brennan (29:00) But chances of.
Scott Call (29:01) Us signing a three year term are very low for that reason, not anything to do with medallion. But for that reason, so if you could also give us a cost on just a one year term would be helpful as well.
Fatima Nunes (29:18) Absolutely. No. I understand. I know, you were pretty candid about that experience that you had. So typically, we don’t offer one year agreements. I’ve seen two year agreements get approved and Dave can shed a little bit more light on that. He would be the we’d go back internally for you. I think ultimately, what we see a lot of organizations are in similar shoes where they’ve had negative experiences with other vendors and they say, hey, leadership’s not letting me sign anything past X many number of months… when they see the slas that are built into the agreement where, hey, if we’re not performing to the standards or the expectations that we set, then that’s your out, right? We’re breach of contract. And then of course, like our legal teams can kind of wore it out but that’s really what gives them the peace of mind of, hey, we’re not going to be running into these issues again because there are contractual slas in the medallion agreement that would kind of mitigate some of those risks. Do you think that would be, that would help mitigate some of those like three year term concerns or do you think it would still be, hey, it doesn’t matter. I.
Scott Call (30:24) Don’t know well, we’ll have that conversation and kind of see where that goes and we could bring that back. But yeah, just knowing our C suite decision makers, the way we do, that might be a lengthy conversation that we’ll have. But, yeah.
Fatima Nunes (30:39) Okay. And Dave, I see you came off mute. Did you want to?
Scott Call (30:41) Add anything? I was just.
Dave Wallach (30:42) Going to Healthstream everything Fatima said. It’s, very, rare to see a one year deal and usually be, you know, for a significantly high annual, higher annual amount, if it was.
Scott Call (30:53) Approved. Three years are standard.
Dave Wallach (30:55) We can, you know, two years is much more realistic. But the main thing is the slas in the contract, I don’t want to repeat everything she said, but if we breach, I mean, if we.
Scott Call (31:04) miss specific amounts of.
Dave Wallach (31:06) Slas, we are breached and you’re free to walk so, but, we can always go over that later.
Scott Call (31:10) Got it. Yeah. Okay.
Fatima Nunes (31:15) Great. So it looks like this is in line, let’s move forward. So option two just kind of go back. Option two, it’s going to include everything in option one. So all of the delegation support, caqh management credentialing, the only thing that changes is where you’d be consolidating that facility credentialing vendor that you use today, and then you’d be bringing it with medallion, right? So for option two, on a three year term, again, you’re looking at an average annual cost of 104,000, 792 dollars. The year over year breakdown is outlined there similar to the previous slide. Year one comes in higher at one oh four because of that implementation fee. And then the initial credentialing of all 200 providers, years two years three, that drops to 96 K.
Scott Call (32:01) And then I.
Fatima Nunes (32:02) think the biggest, right? When we were thinking about different options here, we know how much of a headache it’s been to manage multiple vendors. So we’re trying to get ahead and give you some different alternatives at what we feel is like a cost makes sense from a cost perspective, where in this scenario, you would continue managing just two vendors. It would be medallion and your payer enrollment vendor versus you add medallion as a third vendor. And then you have facility credentialing payer enrollment and then medallion. So this would just make things I think transparently between us, make life easier for you, Neil… but of course, I don’t know what leadership’s appetite for consolidating one of those vendors is.
Scott Call (32:49) Okay. Do you, I know.
Fatima Nunes (32:50) Last time we spoke Scott, you mentioned you’d need to pull the contracts on your existing vendors to know exactly what you’re paying today. But just based off what, you know, do you feel like we’d be competitive with what you’re currently spending on that facility, credentialing vendor?
Scott Call (33:05) I’ll tell you when I see option three?
Fatima Nunes (33:07) Okay. I’ll be.
Scott Call (33:08) Able to leave you a much better idea if I look at option three? Yeah.
Fatima Nunes (33:12) Okay, great. So, option three?
Scott Call (33:14) So far, yes, so far?
Fatima Nunes (33:16) So good. Well, you haven’t fallen off your chair, so that’s good.
Dave Wallach (33:18) I just want to, before you move to three. I just want to clarify you have one vendor, is that correct? Specifically doing the facilities?
Scott Call (33:24) And you have another?
Dave Wallach (33:25) Vendor doing the individual provider enrollments to the payers. Is that right? Right? Got it.
Fatima Nunes (33:31) Okay. So last option, it’s all of it end to end support. You’d consolidate those other vendors that you have. Everything would come to medallion one platform. Everything lives in the medallion platform. And then this is what we’re looking at, right on a three year agreement, average annual cost comes out to 341,000 with the same story you saw in the previous two options, year one, slightly higher because.
Scott Call (34:00) Of implementation.
Fatima Nunes (34:01) And some of those initial credentialing, and then the cost drops in years two and years three to about 326,000. I’ll pause there. What are your thoughts now that you see the full picture?
Scott Call (34:19) Yeah, very competitive and happy to see that number.
Fatima Nunes (34:27) Were you expecting it to be higher?
Scott Call (34:29) I know we, for the whole enchilada, yes. Are you, I guess when I.
Fatima Nunes (34:36) hear that, are you basing that based off what you’re currently paying like you’re all in credentialing with the vendors.
Scott Call (34:42) Yeah. Okay. Yeah. What I would love to see and I know hopefully you all are, okay time wise. I don’t want to carry anyone over if they have other meetings, but what I would love to see is if you go back to the very first slide with the financials?
Fatima Nunes (35:01) Here.
Scott Call (35:02) Nope. Sorry, keep going forward. Oh, forward. Yeah, sorry, forward. Yeah, right here. Oh, let’s see. Yeah, that previous… what I’d love to see is… putting in the facilities as option three and putting in the provider enrollment into option two. It’s that just flipping those two, would be great just in terms of how we present this to, our C suite because I think that’s probably the order we would follow if we, you know, if we went that direction, I don’t know Neil. What do you think? Yeah, that’s great. So, if you could just revise those and I know the numbers are going to be the same, right? Either way, but if you could just flip those for us, that would be really helpful… absolutely.
Fatima Nunes (35:52) I can throw it in. OK, I’ll update option two and then it’ll everything in option one plus pair enrollments.
Scott Call (35:58) Yeah. And then adding facilities as option three. Yeah, that would be the way we probably go after this. So you just want to,
Dave Wallach (36:05) change the order of the options?
Scott Call (36:07) Is that correct? Yeah… we wouldn’t have.
Fatima Nunes (36:11) An option Dave. So what Scott is saying is we wouldn’t have an option where it’s all end to end services. Option two would be everything in option one plus pair enrollment. And then option three would be everything in option one plus facility enrollments.
Scott Call (36:27) Yeah.
Dave Wallach (36:27) So, there’s no scenario where you get rid of where you consolidate everybody to one vendor. Is that correct? Oh.
Scott Call (36:34) Sorry, maybe I didn’t make sense. You could put option four and put that… no, I’m just saying option one would be just like you have it, option two would be option one plus PE only.
Dave Wallach (36:48) PE only.
Scott Call (36:49) Yeah, option three would be end to end. I got it. Okay.
Dave Wallach (36:53) I understand. So swap out facility enrollment with PE.
Scott Call (36:56) Yes. Yeah, that’s all I’m saying just flipping the order.
Fatima Nunes (37:03) And just to go back to Dave’s question, out of curiosity, I know that the leadership team is very risk averse, they like to test out vendors before committing right to just one vendor, which is why you have kind of the situation that you’re in. Yeah, do you?
Scott Call (37:16) Think based on the price that?
Fatima Nunes (37:19) We shared with the all end to end services, there would be appetite to consider that. I know both of those other vendors have.
Scott Call (37:28) Talked about Fatima’s exploratory questions. They’re so good.
Fatima Nunes (37:33) I just have all these thoughts.
Scott Call (37:36) Yes, I think there would be appetite to explore that or at least have an in depth conversation about what that looks like in terms of implementing that direction. Okay. Fair enough. Perfect. Yeah, yeah.
Fatima Nunes (37:54) So in terms of this is all I had for presentations, what I’d love to do, set up another call so we can add in that.
Scott Call (38:03) For, I guess third.
Fatima Nunes (38:04) Option or update option two, and you could see what the cost of that is.
Scott Call (38:10) I know.
Fatima Nunes (38:12) That you’re evaluating other vendors, let me stop sharing here.
Scott Call (38:15) Do you, I have an,
Fatima Nunes (38:16) idea of when I guess when we first met about two weeks ago, now, you mentioned you had a 10 to 14 days to make a decision. Is that still the timeline that you’re operating on?
Scott Call (38:28) Just through a meeting on our calendars, when was it Neil? You just accepted it? It’s about… 10 days out from now. So that will give Neil and me the opportunity to put the numbers together. And then that meeting I scheduled with Jim and Jonathan so that we could run through all those final numbers and start making solid decisions. So, yeah, that’s about 10 days from now when we’ll start really making hard decisions.
Fatima Nunes (38:59) Okay. And I appreciate the additional context there. So is the goal to have a shortlist or have a vendor of choice before having that conversation with Jim and Jonathan or is it to provide them the different options and then kind?
Scott Call (39:11) Of delegate over it what I would like to do and Neil, this is probably we haven’t talked about this in depth, but I would like to put it all together and then Neil and I will be meeting to review it and we’ll I’ve told Jim and Jonathan that we will be coming to them with a recommendation. So now that conversation can go an entirely different way in that meeting in 10 days. But yeah, I’d like to go in with a recommendation for sure. Perfect.
Fatima Nunes (39:38) Well, whatever we can do to help solidify and help you in that process. Me and Mallory and Dave as well. You have our full support there in terms of getting you the updated scope. Should we look at finding maybe sometime either Thursday, I’m looking right now, Thursday afternoon and Friday afternoon, that’s pretty open for us.
Scott Call (40:06) Of this week of this week if you prefer earlier.
Fatima Nunes (40:09) Next week, we can do that as well. And I don’t know if maybe that would give you enough time to work with revcycle on some of the other pieces of data that we’re looking at. And then we could maybe.
Scott Call (40:19) just combine.
Fatima Nunes (40:19) And have more of a fruitful conversation where we can update more of the slides that we have.
Neil Brennan (40:30) If you’re reviewing it, my calendar’s up to date.
Scott Call (40:33) Yeah.
Scott Call (40:37) Seven o’clock Friday look. Fuck, yeah… no, actually anywhere between 11 and two 30 eastern.
Fatima Nunes (40:49) Let’s do, let’s do. Oh, I was just looking at my own calendar. Selfishly let me see what everybody else’s looks like. One 30 looks, one 30 to two eastern works on me, Dave and Mallory’s calendar that works for you all.
Scott Call (41:05) Okay. Yeah, I think, that sounds great. Perfect. Okay. I have one quick question. Sorry about that, please Dave.
Neil Brennan (41:16) And Fatima and Mallory may.
Dave Wallach (41:17) Already know this question, but Scott and Neil, what is driving the decision in the next 10 to 14 days?
Dave Wallach (41:27) You make a decision, I guess what’s driving that timeline?
Scott Call (41:31) The timeline, correct? Yes, honestly, just time on our calendars. So, you know, we’re looking to make a decision this month, you know, 100 percent as we’ve told them by the end of the month for sure. And that includes the meetings with our CEO and CFO. So, yeah, it’s just time to put the data, together, collect everything and then get it into a presentable kind of format. I’m sorry, Scott.
Dave Wallach (42:00) Let me ask a slightly different. I just first making the decision, let’s say in the next month versus six months from now? Is it purely just an initiative to try to accelerate revenue and capture unrecognized revenue and time is money or is there something else driving this?
Scott Call (42:17) Decision?
Dave Wallach (42:18) Sooner than later.
Scott Call (42:20) I think that’s it, Dave, knowing that, and we’ve talked about this as well prior to today, but knowing that there’s a pay or look back period, you know, we understand that we need to get this moving ASAP and not sit around waiting because it’ll be, you know, months before we actually start seeing this come to fruition and seeing the benefits of this. So, yeah, sooner the better for us. Okay, great. Yeah, I just have.
Fatima Nunes (42:46) One follow up question there because you’d be surprised how many times we hear we’re going to make a decision this month and what that means is we’re going to talk about it this month. And then we’re going to sign off on something in the next six months. And then we’ll have something implemented early next year. So just to clarify when you say make a decision this month, is that having, you know, kicking off implementation early may and having everything finalized in April or what does I guess making a decision look like internally for you all?
Scott Call (43:13) Yeah, I… don’t know that we’re going to control that. I think it will depend on that conversation we have upline. But I mean, I think, you know, we’re driving, I would love to see a final vendor selection by the end of the month with contracts signed, you know, halfway through may. Okay? So yeah, we’re not looking at next year or even three months from now. We’re anxious and very serious about moving forward, right? Okay. Because this stuff.
Neil Brennan (43:44) This stuff was brought up. Like I said, it was brought up in meetings last year with the C suite. You know, they started talking about, we need, we want this to roll this out and have this done in 20 26. Scott and I asked for time. Hey, can we look at this at the beginning of Q2? Can we get through Q1? Because I think I also mentioned that, you know, I had a, there was a facility credit, but I had five people that report to me. Three of them used to report to me. Two of them used to report to Scott and we’ve recently as of March first.
Scott Call (44:10) Merged the.
Neil Brennan (44:11) teams, the facility credit and the proprietary credit teams together. So it was like, hey, let us do this hurdle first and get through this with Q1. Q2 will then focus on, you know, what it takes to be delegated, find a vendor, get this all propped up rolled out as soon as possible. So that’s the reason for the timeline because we want this up and running, it stood up propped up running and running effectively.
Scott Call (44:32) You know, by the end of the year. So we looked.
Neil Brennan (44:35) At the beginning of Q2 to make a decision, do all these demos talk with all these, you know, you guys and all the different vendors, and then make a decision, sign a contract and get it going.
Scott Call (44:44) Absolutely, absolutely.
Fatima Nunes (44:45) Well, the last thing we want is to push things at an unnatural pace. So, whatever you need from us, I know we have a lot of implementation resources. We have a head of implementation once it’s the appropriate time to just fill in some of the gaps there around how long this will take, what you can expect from implementation. The great thing is we’ll move as fast as you need us to. So there wouldn’t be an issue there.
Scott Call (45:09) But I appreciate.
Fatima Nunes (45:11) The additional context and I don’t know Dave Mallory. Anything else? I know we have, we’ll have some time set up. I’ll send out the invite for us to chat at one 30 on Friday and.
Scott Call (45:23) Review?
Fatima Nunes (45:23) The updated options, anything else?
Scott Call (45:25) No, thank.
Neil Brennan (45:26) You for your time today, pleasure?
Dave Wallach (45:28) To meet you both. Where are you based? I meant to ask earlier.
Scott Call (45:33) What’s that, where?
Dave Wallach (45:33) Are you based out of both of you?
Scott Call (45:38) I’m based here in the greater Orlando area, and I live in Dallas, but I commute into Florida just about every week. So I’m here, I live here as well. It feels like I live here in the Orlando area. Yeah. Okay. Yeah. Got it. Fatima’s.
Dave Wallach (45:56) Heard this too many times. My wife would have a backpack tonight to move to Florida. So I always like to hear that.
Scott Call (46:04) It’s cool. I like it here. Fatima very good job. I would say today, differentiating medallion from our competitors. You know the landscape well, and it’s evident that you’ve done your homework and that’s very helpful for you to set yourselves apart in terms of our recommendations going forward. So, thanks for that.
Fatima Nunes (46:24) No, absolutely. I appreciate that. And I think it was possible because of all the information that you and Neil have shared in these conversations, we wouldn’t know how to plug in if we didn’t understand your current state. So, appreciate the time and the additional 17 minutes you guys gave us. I think we need to give up on the 30 minute calls because they’re just not for us. We’re one hour call people. So.
Neil Brennan (46:45) Yeah, awesome.
Fatima Nunes (46:48) Well, I hope you all have a wonderful rest of your afternoons and we’ll talk on Friday.
Scott Call (46:51) Thank you. Thank.
Neil Brennan (46:52) You. Of course.
Scott Call (46:53) Bye.