Transcript
Patrick Calamare (00:00) hey, Molly. How are you?
Molly Dwyer (00:02) I’m good. How are you doing good.
Sami Alouani (00:04) Good, good. We woke up today, so it’s a good day.
Molly Dwyer (00:07) Thank you for joining this call first thing.
Patrick Calamare (00:11) No worries. I.
Molly Dwyer (00:13) Appreciate it. Are you heading out on a trip? I see or?
Sami Alouani (00:18) Yeah, I’m actually going to the India office tomorrow, which will be exciting. Yeah.
Molly Dwyer (00:24) That’s really exciting. Are you going alone or who else from medallion is going?
Sami Alouani (00:29) I’m going alone initially and the rest of the team. So we got some folks from ops like Nicole and our new bizops team as well as Nate, our new coo, they’re going to join me next week. I just have to leave a little early because I’m heading to Hawaii after.
Molly Dwyer (00:46) Amazing.
Sami Alouani (00:47) Yeah, it’s going to be a busy couple of weeks, but a good couple of weeks.
Molly Dwyer (00:51) That is awesome. All right. Pat’s in the room so I’m going to let him in excellent. Hey Pat.
Patrick Calamare (01:09) Hello, can you hear me?
Molly Dwyer (01:12) I can hear you. How are you?
Patrick Calamare (01:14) I’m good. How are you? I’m.
Molly Dwyer (01:16) doing well. I feel like it’s been a bit since we last connected. Yeah, you.
Patrick Calamare (01:21) Going. All right.
Molly Dwyer (01:22) Things are busy. How about you? I’ve heard definitely very busy on your end?
Patrick Calamare (01:27) Yep. That’s for sure off to a hot start.
Molly Dwyer (01:32) Off to a hot start. I know like the first quarter is always, it’s always crazy busy and you feel like it’s going to slow down, but it doesn’t so we appreciate you making some time and just reconnecting. And I know you were supposed to connect with Derek last Friday?
Patrick Calamare (01:46) Yeah, we had to reschedule.
Molly Dwyer (01:48) Yeah. So, did that get rescheduled for this Friday?
Patrick Calamare (01:52) I think it’s this Friday morning. Did you talk through some of the like AI, we were talking about the, some of the AI features you were rolling out?
Molly Dwyer (02:06) Yes, yeah.
Patrick Calamare (02:09) Yeah, this Friday.
Molly Dwyer (02:10) All right.
Molly Dwyer (02:12) So, really the kind of the Genesis behind this and also brought along Sammy, who is our head of technical solutions was just really first, I think aligning on, you know, the use case for medallion and also supporting the data migration. So, wanted to kind of talk through, some of that work with you today. Ideally. We’re going to connect with you after, your conversation with Derek, but I think just given the importance of, you know, this work and just kind of the current state of the partnership. Just wanted to align with you there first and talk through, some options that we have.
Patrick Calamare (02:48) Okay. Sounds good.
Molly Dwyer (02:53) Kind of taking a step back. And this is where I wanted to begin aligning with you on. Let me pull this up a little bit. So kind of the Genesis around this is recently working with Carrie and the team. They had asked us to do like an import of a large volume, of power analysis or like payer validation, essentially power validation across a number of enrollments. And so when doing that import, we kind of came to the understanding that a lot of the data for those enrollments is not currently in medallion, which created a lot of friction and just a lot of like heartburn for your team. And so that kind of just raised from our standpoint, it was like kind of an understanding like wait, not all your data is in medallion. So that’s something that we definitely wanted to talk through and just understand a bit more about. Like is there a reason why there is a data in there? And ultimately like how we can help support that process and really reach this ideal state? And if you want to share more a little bit there Pat?
Patrick Calamare (03:59) And what kind of data? Like was it just enrollment data? Like the actual plan data that the providers were connected to or provider data? Like the providers were missing?
Molly Dwyer (04:08) Yeah. So it’s a combination of both it’s like provider and enrollment data. Both of those like from our understanding is like there’s not a complete picture of the data currently in medallion. So that creates like a lot of downstream impact when we are doing enrollments and just the work that we need to be doing, we don’t have that full picture of the data. So that ultimately is like where we want to start. This conversation is like one, how can we support getting the data into medallion? But also from like a broader strategic standpoint, like where are we aligning for? Like an ideal state for medallion? Like do you want to be using medallion as that source of truth for your data?
Molly Dwyer (04:49) Does that make sense or need more context there?
Patrick Calamare (04:52) No, no, that makes sense. I don’t think medallion… I would consider to be the source of truth for our data. I think that’s one of the challenges… that we have, right? Because the… future ideal state for medallion, I think is different than how we’re leveraging medallion for obc which kind… of, I think makes it challenging for all of us. I think for obc’s perspective, it’s a lot like right when I talk to Derek and Scott and you, I mean, you’ve got a fantastic platform, right? It’s more of a credentialing… solution. A technology solution is how it should be thought of. And I think the way we’re leveraging it with obc is it’s more like capacity… support, you know, workforce augmentation type work to help us with ovcs… have pretty significant… business challenges, large tin restructuring efforts for two straight years that’s required a.
Sami Alouani (06:11) significant.
Patrick Calamare (06:12) Amount of resources from our team to support. And that’s where we’ve really been using medallion to help come in. It makes sense why you would, right? Having the whole network would make it easier to do those pieces. So, I think there’s some discussion that we need to have there to figure out how we meet both needs. I.
Molly Dwyer (06:35) Think that’s like kind of where I want to expand this because ultimately like if you’re using medallion to help augment or supplement the work that your team is doing, absolutely, like we can completely, we worked with lots of organizations that are doing that. But the challenge is that when we don’t have a full picture of your data, allocating any work to medallion for, specifically for pay enrollment, becomes a lot of friction or creates a lot of friction for both teams and creates a lot of friction for us to be delivering upon the value that we provide to our clients, which is that faster turnaround time, which is a centralized view of your enrollment data at all time et cetera. So that’s really like where we want to help solve for, is like in order for us to be able to take on work, you know, and kind of flex as your team needs us to, we do need to have that data set. And so just kind of beginning the conversation of like one like assessing like how much data is not in medallion today? Like do we know that? And like really, how can we partner together to bring that data over to medallion so that you can use us? You know, depending on how your team needs us from a capacity standpoint. And really like as your needs evolve… does that align kind of with what you’re how you’re thinking about this as well? It?
Patrick Calamare (07:46) Does I think it makes perfect sense? I mean, how are we, how are we expecting you to do the work that we’re asking you to do if you don’t have access to the information to do it?
Molly Dwyer (07:55) So, exactly… and Sammy, I don’t know if you have like any questions that you wanted to ask about? I know that we kind of are in a discovery process here just figuring out more about your data… yeah.
Sami Alouani (08:10) I mean, only context here is, you know, Pat when we say like source of truth, I think there’s you know, that that’s a very loaded term. And so what we’re really talking about here is like source of truth for specifically your enrollment data. And, you know, potential, you know, integrations and touch points both upstream and downstream from that. But ultimately, you know, the ideal state is we’re kind of doing the work and have the latest and greatest specifically in that domain. And so if we, you know, the first step, to getting to that status, is to Molly’s point like figuring out like where does your existing enrollment data that we’re not touching today? Live? What do the mechanisms of transfer look like? So that we can ingest that information? And then lastly, like how do we capitalize on having all of the enrollment information in a single system of record? So yeah, just mostly doubling down on what Molly says and, or said rather and here to help figure out logistics of transfer, if that is a path we want to go down.
Patrick Calamare (09:04) Perfect. No, it makes sense. And yeah, I’m curious because I talked a little bit in preparation with Carrie for this call, but we didn’t talk too much about the data migration. So I’m curious kind of what her, if you’ve have you had conversations with her about that?
Molly Dwyer (09:26) We started to and I think where we kind of paused is one just like wanting to reset from like a broader level, like is the ultimate goal like aligning one? Like what the goal is to be using medallion. I think you provided that clarity today so that’s perfect. And then going from there, I think where we have gaps today is like understanding to your point? Like where are the other data sources that are not the data’s not that’s not in medallion, like where are they? And ultimately like discussing some options with Sammy and his team on how we can migrate that data, like what that’s going to require from a resourcing standpoint on your end, how we can come into support where we can really help, you know, provide consultation, and guidance et cetera. So that’s kind of where we are today. But I think, you know, definitely happy to discuss more in terms of like what we’re thinking about in terms of options et cetera, if it would be helpful?
Patrick Calamare (10:23) Yeah, that’d be good to go through these if you have any options here. The other thing to just keep in mind in the background, right? So I mentioned just kind of the chaos that is the obc business tin restructuring. We’ve been doing rapid enrollments for two straight years. It’s been, it’s been a challenging environment… and there’s a lot of… I would suspect a lot of outstanding data that needs to be updated refreshed. But what we have is what we have on top of that, we… the team through a whole migration to a new credentialing software with mdstaff that… we’re still working through. But we’re at the tail end of at this point which is exciting. So at least we can start using a central source instead of a few, you know, they were using a few different sources really in the past which I think would make it challenging to do what we’re talking about. But at the end of the day, what we want on the optum side, all of the data will be stored in mdstaff. That’s what we’re building those integrations, Sammy that you’re talking about with… and medallion would be helping to empower that. But that’s in my mind what we should be comparing when you say obc data, it should be to MD-Staff, not verity, not smartsheets, MD-Staff Pat.
Sami Alouani (11:53) Could you help me understand what the scope of what you’re using MD-Staff for is today, is it truly more so on just the cbo operations or is there any overlap between medallion and MD-Staff? Are you the actual payer enrollment process?
Patrick Calamare (12:10) There is, so we’re using it for more than credentialing process and workflow and data collection. We use it for enrollment as well processing not only applications that are pending and out but data that we get back from the payers on their enrollment statuses? And then even for groups like obc where we have employed provider groups, even a step forward more for general provider data as well as we work with operational and onboarding teams that within our organization. You know, we need to collect some information in there about the providers to really maintain it. Like things like employee id, for example… that’s really kind of the scope of it all that.
Sami Alouani (12:54) Totally makes sense question there on the overall or I guess two questions. Really. One, is it fair to say that between medallion and mdstaff, and I know you mentioned you’re kind of at the tail end of that migration. So let’s just assume we’re you know, we got the final hangnails out of the way and you’re fully kind of that onboarding process is wrapped up. Is it fair to say that between medallion and mdstaff, all existing enrollment information would be housed between one of those two systems today, or would there be other places?
Patrick Calamare (13:23) That would be fair to my knowledge. It should just be those two because they were storing stuff in verity before, which is why we all migrated to mdstaff. I don’t think they were storing any enrollment data in smartg that was more with that onboarding coordination and credentialing workflow.
Sami Alouani (13:38) Got it. Yeah. The in flight during the migration. That makes total sense. And then do you have, if you could just give like super layman business logic for like what you would, what today routes to medallion versus what today routes to mdstaff? And with regards specifically to payer enrollment, what would that business logic be?
Patrick Calamare (13:59) I think that’s a good question. And I don’t think I could give you it in layman’s terms. Speaking with Kerry. I know they’ve had some challenges with work that they’ve sent back and forth and has caused them to pivot quite a bit around to try and get the most kind of usage. And again, one of the major priorities has always been speed. At the end of the day, we’ve got a lot of volume to get through. A lot of… this group also seems to have a bit more of an involved and high pressure type of leadership team as well. So a lot of pressure going on here that’s felt that also drives it. So, you know, that would be one I’d want to talk a bit more about with Kerry, you know, because I think that’s something we’ve also, I kind of explained how I would envision the medallion optumhealth partnership working. But I think that’s a good layer down that we’ve got to discuss and align on.
Molly Dwyer (15:00) Yeah, totally. Yeah. And.
Sami Alouani (15:02) Then just kind of a sorry last question there as you’re pondering that with your internal team, like if we could position it as like what would it take for that split to be, you know, basically all payer enrollment route to medallion and everything else, you know, continue to route through mdstaff. Like as you’re figuring out what the current business logic is, what, you know, just thinking about like what it would take for that routing to come to medallion. The reason I say that is, you know, the value of this migration of data really is mostly unlocked once the decision is like, hey, that enrollment, those revalidations and power analysis and all that enrollment activity would happen in medallion. So, yeah, appreciate the thought that you and your team are going to put into that. But Molly back to you.
Molly Dwyer (15:45) Yeah, I was just going to say and kind of like voiceover from the conversations with Kerry. We kind of had, you know, a very transparent conversation a few weeks ago where, you know, the experience regarding payer enrollment has not been great like you’re not experiencing the turnaround times that we typically are providing our clients. Like the real value around, you know, working with medallion for payer enrollment or direct enrollment. And I think there is a balance right now of like we need to be able to execute by having all of that data to be able to deliver and really meet those expectations kind of like these projects that we’ve been doing have not been the best experience because of that missing data piece. So just want to make sure that we have like, you know, we can continue to execute on getting this, the migration of the data and having a better view to be able to, you know, test out some of that enrollment with your team and really prove that value.
Patrick Calamare (16:39) Yeah. No, that makes sense. Again.
Molly Dwyer (16:42) Awesome. Sammy. I don’t know if you wanted to speak to some of the options that you’re thinking of then potentially of how we can get the data over, yeah.
Sami Alouani (16:51) Totally up to you all. We’re fairly flexible. Generally. The end goal is that we have an import template that we ultimately need to ingest into medallion. But of course, the goal also is to minimize the pain that your team has to go through if any, to get us that data. Maybe what a good starting point would be and for what it’s worth, we’ve done MD-Staff transitions before as far as data migration… I guess maybe transition is not the right word. I think to Molly’s point, there’s still value in us going ahead and gathering the information such that if and when your business logic changes for what goes to medallion versus MD-Staff, there’s not a concerted… effort every single time we modify that. It’s just like let’s both have all the data. You all make the decisions about where the work is being done in parallel. We can send over our data template just so you all can kind of look at what concepts that we ultimately would be looking to receive from MD-Staff, knowing that, you know, again to make your lives easier, we can be flexible with, you know, how we actually get that data from you all. So would that be helpful Pat, just as a starting point is kind of getting the template with the concepts we’d be looking to ingest into medallion?
Patrick Calamare (18:00) Yeah. Like roughly, how many fields are you looking for? Yeah.
Sami Alouani (18:05) Let me, I can actually share my screen here. Just give you a really quick run through. Can you see my screen here?
Patrick Calamare (18:14) Yeah.
Sami Alouani (18:15) Of course. Yeah. And the only thing I ask is as I go through these tabs like just like move your head slowly towards the camera to let me know that it’s too small. I always forget because it doesn’t like automatically, you know, keep the zoom but I digress. So for providers, we should have the majority of this data. Obviously for the providers we’re performing enrollments for this is really straightforward information here. I’m just providers email mpi, their profession, first name, last name, and then their start date, caqh number and social. And the reason this is so minimal here is because if we haven’t talked about it, we do have that native caqh integration where we’ll use this bare information here to pull all the other provider profile things like their work history, their education history, their licenses, their board certifications, all that stuff we’ll pull from caqh. So we wouldn’t need any of that… next again data we largely have at least, you know, the concepts of maybe just incomplete would be your group list. So this is, I’m sorry, your practices list. So the just the list of practice locations that we might need to enroll a given provider under… the mapping between providers practices and groups that tells us, you know, when dr smith needs to be enrolled at the given payer, this is the tax id that we need to enroll under. And these are the practices we need to send to that payer. So just kind of a crosswalk of the three concepts we already have. And then I’m going to skip over here. This is really the meat and potatoes of the import which is the existing enrollment data. And so that’s this is really one row per provider per payer per practice location. So if a provider has two practice locations that they frequently practice at, and we want to enroll them with two payers. We would expect four rows of data here. And that kind of, you know, blow up of data so to speak is something we can work through with you all. So like if that’s a challenge, just let us know. But that’s the ideal state we need to get to is one row per provider per payer per practice location. And then the data that is included there again is just the provider identifier, the name of the payer, the state of the enrollment, the par, the status which we would imagine all is going to be par effective and reval dates if you have them, we understand too that some payers, you know, don’t provide that info until like 90 days before the reval is due and you might not have. Historical effective dates because they weren’t recorded or, you know, whatever the case be there, the line of business, just a boolean binary to say like what is this commercial medicare advantage, medicaid etc, and then last, but not least the practice and the group that we talked about. So very high level. If we can get that information, there’s a little bit more nuance and detail. We can work through with your team, of course, but at the highest level, that’s really what we would need in order to be able to confidently say, like when you’re ready for us to expand the scope, hopefully for us to expand the scope of the enrollments we’re working on, we’ll be ready to go with that Adn platform.
Patrick Calamare (21:17) Yeah, that’s not too bad.
Sami Alouani (21:20) Love to hear that. We can send that over as a follow up to this call as well, just so you have it. Perfect.
Molly Dwyer (21:27) Awesome. And I think for the other components just like understanding who from your team Pat. So I know Carrie and her team had completed some of the import for the last project for power analysis and like inheriting some lines enrollment lines. But would it be the same team that would be owning this? Or is there anyone else from like the data or technical team that would support?
Patrick Calamare (21:57) My original thought was it would just be Carrie’s team… depending on how complicated it gets. I mean, again, that seems pretty straightforward. So I’ll talk to Carrie but let’s start with Carrie and just the team. Okay, I’ll ask them if they need any help and then we can pull in some more like data analysts to help if they need to get a bit more creative, but I’m pretty sure that’s how you can pull it straight out of mdstaff. So that’s the big question is how stable is that data? And confident are they in it? That now we’re using it? I know they’re using it to generate rosters. So I feel like should be able to provide what you just showed, but I’ll get that clarity from her.
Molly Dwyer (22:39) Okay. Yeah. That’s like typically it’s figuring out like where is the data and is it clean? So that would be amazing if we can trust that data and we can definitely hold a kickoff like I kind of put together some next steps just thinking through like ultimately where we are today and getting this project to completion and so definitely want to align here on some of the suggested due dates et cetera. But just to kind of give you an idea of what we’re thinking in terms of the next steps essentially like data migration pre work. So just speaking with Kerry assigning some of those stakeholders and then assessing the current state of the data outside of medallion, we can share with you that import template. I had suggested a due date by the end of this Friday, but please let me know if this is completely like out of line and not feasible. And then from there, we can also schedule a more in depth like review with someone from Sammy’s team, just reviewing the actual template. The team is pretty familiar with it from the import that we recently did. But if needed, we can review it again. And then from there any recurring calls to help ensure that this is executed to completion. But I guess my biggest question is just in terms of timing from your standpoint.
Patrick Calamare (23:55) Yeah. And the other caveat is I got a week of bto in the middle there too.
Molly Dwyer (24:01) Good for you.
Patrick Calamare (24:02) So I… kind of wanted to get with Carrie and talk through the whole proposal, get some of her thoughts on it. I mean, what you’re saying to me makes a lot of sense but I’m just curious to get some of her feedback as well. So I’ll plan to do that this week with Carrie and the other question because again, I’m I’d… say probably 85 percent sure that it would be mdstaff would be the only outside source Sammy like you were asking, but I just want to make sure because I’ve been burned in the past when I’ve thought other teams have not been using other systems when they are. So make sure they’re not using the sharepoint for anything like this or continuing to use verity which definitely shouldn’t be the case. So it’ll be good checking for me anyway with them. So give me this week to do that… a line on a resource plan?
Patrick Calamare (25:10) Can we just push like the first date to the 20 fourth? And then I think everything after that would… make sense? Yeah, you can just follow the same kind of dependency timing.
Molly Dwyer (25:24) Awesome. Okay. I will update that and just share this out with both you and Carrie. And then if we need to schedule a follow up meeting before or after your pto, we’re happy to do. So really appreciate you talking through everything and aligning with us today.
Patrick Calamare (25:38) Oh, this is good. Yeah, thanks for setting it up.
Molly Dwyer (25:42) Where are you going on pto anywhere fun.
Patrick Calamare (25:44) Florida, a little more warm, finally, you’re in Massachusetts, right? I think I remember, I.
Molly Dwyer (25:50) Am, and it’s been a brutal winter, so, I’m very jealous that you get to go to Florida.
Patrick Calamare (25:54) Yeah, I’m in New Jersey. So, just a little like three, four hours south. Yeah, Easter was gross.
Molly Dwyer (26:02) Yeah, it really was. We did an Easter egg hunt in the rain. It happened, but it was gross. We.
Patrick Calamare (26:08) did the same thing, sucked it up, got out there. I think it’s that fun so well, all right?
Molly Dwyer (26:15) Awesome. Thanks so much, Pat. Thank you, Sammy talk soon.
Patrick Calamare (26:18) Yeah, thanks you both. Bye now. Bye.