Transcript
Dave Wallach (00:00) yo, what’s going on? How.
Chris Jones (00:03) much man? How are you?
Dave Wallach (00:04) Good, good. Let.
Chris Jones (00:06) Me ask you how noticeable is this cut down the middle of my nose?
Dave Wallach (00:12) I didn’t see it until you just said it that.
Chris Jones (00:15) Was a rough house with my dog this morning, took a claw and just straight down the middle.
Dave Wallach (00:20) That’s funny.
Chris Jones (00:21) Yeah, fun times.
Dave Wallach (00:24) Hey, Heather. How’s it going? Good morning.
Heather Bogner (00:27) Going well. How are you?
Dave Wallach (00:29) Doing great. It’s a pleasure to meet you.
Heather Bogner (00:30) Good, good. Great to meet you all too.
Dave Wallach (00:33) Good morning. Thank.
Heather Bogner (00:34) you for your patience with me last week. It was a little bit crazy on Thursday, so.
Dave Wallach (00:40) No problem at all. It’s been, it was a busy week. It was the end of our quarter as well. So, you know, it’s it was a busy week all around. So it’s better off a nice relaxing Tuesday morning works better probably for everybody. There you go. So, Heather, I know that we connected over email, just a quick introduction. I lead one of our enterprise sales teams here at medallion. I’m in New Jersey. I’ve worked with Sam in the past here and there, and glad he was able to provide the introduction. Now, we have Chris jones, an Ohio native. I’ll let Chris introduce himself. Yeah.
Chris Jones (01:13) Good morning, Heather.
Chris Jones (01:14) Like Dave said, I’m based out of Columbus and I’m on Dave’s team fairly new to medallion a few months in, but I’ve been in software and technology for quite a while. So pleasure to meet you.
Heather Bogner (01:26) Great to meet you too. Not too far away from Columbus. I.
Chris Jones (01:31) Was going to say, are you on the Cincinnati side or the Kentucky side? Cincinnati? Very good. All right. Perfect.
Dave Wallach (01:38) Excellent. Well, Heather, the goal of the call today, just to, of course, learn about what you’re looking to solve for and for us just to leave the conversation, all three of us just in agreement on whether or not we think medallion could provide any value to you if so great, if not, we can part as friends. But if you don’t mind just to kick things off on your end that’d be great. And then we can take it from there.
Heather Bogner (01:59) Sure background, Heather bogner senior director of revenue cycle. I’ve been with Mayfield. It’ll be two years in August. So when I came on board almost two years ago, we were just vetting software systems to be able to upgrade emr and practice management systems for the company because we had a dinosaur in place. So we went live with ecwe clinical works back in September. So since that time, we’ve been working on optimization of the system. And one of the things that I’ve had in mind since I’ve been here is some sort of credentialing partner. We have a one woman show and she’s strong and she’s fantastic. And one person isn’t scalable. And we have big business growth plans and continually adding providers. And we’ve added service lines. And so I have to find a better way to serve the business… fast forwarding to recently, we’re looking at potential contracting partners. Payr advisor is one of the vendors that we’ve spoken with and I asked them if they had a credentialing recommendation since they don’t have a wing of that. And they recommended all of you. So that’s why I reached out to get some time on the book for us to talk about what you can do and if it might be workable for Mayfield, I’m in the discovery phase. So I’ve looked at a couple of other vendors and balancing cost and benefit and just looking to see what you can do. And I’ll be I’m big on transparency. I’ll be transparent that payr advisor said medallions expensive, but they’re worth it. So that’s what I’ll be wanting to hear about what makes you great and how you can help us and the value add.
Chris Jones (03:47) Perfect. We can certainly share some information. One of the things I’d be curious about though. So you have one person managing the entire credentialing process today. I’d be curious to understand a little bit more about what that looks like in terms of, you know, from a provider side, then also from a payer side, if you’re doing direct enrollments, if you have delegation with any of your payers, do you have any insight into what the current process looks like?
Heather Bogner (04:13) I will share what I know. Okay, she does actually report to me. And back in the day when I was doing independent small physician practice management, I did a lot of this work myself, but that was a long time ago in a small group. So it isn’t like it is here. And now she manages relationships with the hospital medical staff offices and has credentialing and re privileging for all of the providers at the regional hospitals that we partner with, where our surgeons perform surgeries, she manages caqh, she manages the relationships with all of our providers and assists them with license renewals, Dea renewals, she talks our new providers many times they are new out of residency. So they’re just getting started. And so she’s talking them through their state licensure for Ohio and Kentucky through Dea privileging in both states, all of the things that they need to have. You know, if we have providers who change names. We had one recently who got married and changed her name and had to change all of her documentation. My person is managing all of that. And she also is doing all of the provider enrollments for all of the payers that we contract with. So that can be very tedious because it’s one at a time. And again, one person and she gets one shot at it. There’s no shotgun approach to anything. We don’t have any sort of efficiency or economy of scale anywhere. So, yeah.
Chris Jones (05:49) Yeah, that’s helpful. It sounds like she certainly has her hands full.
Heather Bogner (05:53) She does, and she does a great job and there are things that can be done faster, you know? And I don’t fault her for that, but payer enrollments, obviously, you know, they take time, but sometimes we don’t have 90 days. We need to have providers up and running and able to be billable with payers faster than that. And I know it’s possible. It’s just not reasonable with our current process. Yeah.
Chris Jones (06:20) Understood. So obviously that’s a big driver is getting providers billable quickly, which is, you know, one of the main reasons why folks come to us to begin with. In terms of the growth. I think you’re somewhere around 100 providers today. Is that accurate?
Heather Bogner (06:35) Sorry, that’s about 70?
Chris Jones (06:37) Okay. And then you commented on growth and the inability to scale, what does that look like? You said you have growth plans? But what do you expect over the next? You know, one to three years? We’re.
Heather Bogner (06:49) adding surgeons for the independent practice, we’re looking at potential and this is all confidentially that I’m sharing this because it’s not even common knowledge within the company. We’re looking at mso type capabilities and potentially acquiring other practices, okay, potentially becoming revenue cycle function for other practices either through contract or through acquisition. So.
Chris Jones (07:14) That’s exciting time.
Heather Bogner (07:16) It’s exciting. And I have to move fast enough on this to be able to keep up with that.
Dave Wallach (07:23) Gotcha. If I could add one quick thing. Heather, a lot of msos come to medallion for support as well where they might have hundreds or dozens of provider group clients that they say, please handle the credentialing for them as well, right? So that’s a, as you continue to grow that’s somewhere that you could scale with us as well.
Heather Bogner (07:45) That is great to know, Dave. That will be a big boost in the argument for your services. Absolutely. So, thank you. And.
Chris Jones (07:57) Then, are you guys using any kind of software or technology today? Or is it done kind of manually in spreadsheets? And probably the way you were doing it when you were doing it?
Heather Bogner (08:05) It is all manually in spreadsheets. Okay. As I said, I’ve been here not quite two years, and this person in this role has been here 10 years. And what is reported to me is that there was an attempt to push the use of a software platform a number of years ago, and that was unsuccessful.
Chris Jones (08:22) Okay. Got it. Okay. Are you familiar with medallion at all? Have you had a chance to check us out?
Heather Bogner (08:30) I checked out your website, but other than that, I’m not familiar with you.
Chris Jones (08:34) Okay. Well, I’m just going to share a couple slides with you just to kind of paint the high level picture for kind of our charter and what we do. Like I previously mentioned, there’s really three reasons why companies come to medallion for help. So one, they’re looking to accelerate revenue, right? Like you said, it takes too long from a time a provider is hired until they’re enrolled with insurance payers and seeing patients, and, you know, with medallion, organizations are typically able to reduce their, you know, credentialing times and pay enrollment by, you know, 50 percent or so. So, you know, one of the benefits of that too is you’re you know, eliminating claims, denials and write offs and, you know, we’re kind of taking some of the human element out of it with AI and automation, but we can talk more about that. Another reason is to reduce operational costs, right? So you commented on, you know, you’re growing right? And you’re not scalable currently. So typically, if you were gonna, you know, continue managing things the way you are today. You’re gonna have to throw more headcount at it. So, you know, we enable our customers to manage the entire credentialing process to scale with minimal resources. So you have one person today that’s more than enough to be able to handle your entire credentialing processes through medallion. And then the last piece you didn’t really comment on that, I don’t know if it’s an issue for you or not, but it’s just, it’s removing provider abrasion, right? So, as you’re aware credentialing’s you know, painful and can be frustrating for providers especially with, you know, with new providers joining, that may be going through some of these things for the first time. And then because of our AI and integrations, we’re able to reduce that burden. So, you commented on caqh, we’re a participating member of caqh, which means that, you know, 90 percent of the, you know, credentialing docs can be automatically pulled into medallion. So there’s a direct integration there that alleviates a lot of the pain that providers would typically see.
Dave Wallach (10:28) Chris, real quick. I’ll let you catch your breath real quick. I just want to double dip on the caqh piece. And when we do a demo, hopefully as a next step, we’re going to show you this, but you might be potentially talking to other vendors that also say they have a caqh integration. We’ll show you but we’re the only vendor that as Chris said is a participating member. Basically, we have our own direct instance and connection into caqh. If any other company has an integration, it’s going to be through an API that they would build and they would need passwords and logins for caqh medallion. All that we need is the caqh id number and the social security number of the provider, and we pull all the information directly through caqh. So it’s a much better experience. I just want to double click on that.
Chris Jones (11:14) Yeah, yeah. Thanks, Dave. Good call.
Heather Bogner (11:16) Okay.
Chris Jones (11:18) Yeah. Okay. So, yeah.
Heather Bogner (11:22) Real quick, Chris. You’re right? I didn’t mention anything about provider abrasion because that’s been something that actually has kept things the way they are because our providers are very happy with our person and they feel that personal connection. And that’s a point of hesitation for me. Looking at the AI provider outreach that you talk about because I could see that as being a sticking point with our shareholders with our surgeons because it will be less personal than what they’ve been accustomed to for a number of years.
Dave Wallach (11:53) One quick comment, Chris, and then I’ll let you go through the slide is with medallion and we’re going to paint the picture of what we do a lot of the outreach that we’re going to do is with the payers. There’s going to be a lot of automated tasks and digital communication with your providers. But what’s her first name? I’m sorry, we keep saying her, but the I’m.
Heather Bogner (12:16) Sorry, Laura. Okay. My person is Laura.
Dave Wallach (12:20) Okay, great. So Laura is going to be able to be a little more strategic and much more hands off the process. Like again medallion’s going to do the follow ups with maybe the hospitals or the, and send the applications out and follow up with the payers. She’ll be able to work even close more closer closely with your providers and that VIP experience. So I think that’s we usually don’t call or reach out directly to your providers unless it’s through medallion. So that’s one thing I want to clarify, but Chris, go ahead.
Chris Jones (12:51) Yeah, yeah, for sure.
Heather Bogner (12:52) That feels better.
Chris Jones (12:53) Yeah… that element would still be there. So, but yeah, like deysa, we are an end to end platform. So, you know, think about us everything from your provider data management to, you know, primary source verifications, direct enrollments, you know, delegation is something you’re seeking down the road. We can help you with that. But, you know, obviously being an enterprise grade platform, you know, comes with a single pane of glass and, you know, monitoring you’re tracking expirations, reporting analytics. So you’ll have complete visibility over the entire process and then just to kind of go back to the point. So what would a day in life look like for Laura? So in reality, you know, it’s making requests, right? Requesting a credentialing file, requesting payer enrollment. And then, you know, she’s hands off and then medallion’s going to own all of that follow up that Dave talked about, right? We’re communicating with the payers to make sure that we’re pushing the process and getting things completed as expeditiously as possible. And that kind of eliminates that piece which I’m guessing Laura probably doesn’t love is, you know, making all those phone calls and emails and follow ups. So we’ll take that off your hands. You can still have that white glove service with your providers.
Heather Bogner (14:03) And then,
Chris Jones (14:05) the good news is this is, although it looks, you know, it is an end to end solution. It’s all a cart, right? So, you know, the components that apply to your business are kind of what we would solution for you. So I’ll pause there that’s just kind of a quick snapshot of who we are. Does that make sense? Do you have any questions or thoughts that makes.
Heather Bogner (14:25) sense? No questions. Yet, I’ll jump in and ask them as they pop up though.
Dave Wallach (14:30) I do have a quick question. So, in your workflows you have let’s just say 70 Ish providers today, are all of, do all of them require privileges to other regional or local hospitals to perform procedures? Are they all getting privileges somewhere else?
Heather Bogner (14:48) Not all of them, no, we have a large number, say 25 Ish physical therapy providers who obviously are not credentialed at hospitals but our surgeons and most of our nurse practitioners are. So it’s you know, roughly a third split for surgeons, advanced practice providers and… physical therapists. Okay?
Dave Wallach (15:14) So, I would imagine that Laura part of her, I’m sorry, two.
Heather Bogner (15:18) thirds of our people need credentialing at hospitals. Yeah, perfect.
Dave Wallach (15:22) So, I’d imagine that Laura, part of her process is to send out applications to the hospitals, right? For your, you know, for those two thirds or so, the rest for insurance purposes, she’s directly enrolling each new provider to get enrolled in the network. Do you know how many roughly payers each provider is enrolled with?
Heather Bogner (15:48) All the big ones. And obviously medicare takes a larger chunk of time than we would like medicare medicaid, all the big payers, we.
Dave Wallach (15:58) Usually see like 12 as an average. Do you think it’s around that roughly? We can always fine tune that. I think.
Heather Bogner (16:04) We’d have to fine tune it. Yeah.
Dave Wallach (16:06) Okay. That’s fine. No problem. Got it. And are you familiar with delegation, what that means or have you heard that phrase before? Okay. I think you’ll be big enough soon, but delegation is basically minimum threshold and it is independent with each payer, right? So it just depends on each payer usually have about 100 providers with it. You know, under 110 is usually the threshold. And what that would mean is it’s like the north star that a lot of provider groups are looking to get to, which allows you to essentially bypass directly enrolling your providers and waiting the 90 to 150 days.
Dave Wallach (16:48) And I know it sounds amazing here’s what it means medallion one of our services… we are an ncqa accredited cvo credential verification organization that’s what we are.
Heather Bogner (17:03) Okay. What?
Dave Wallach (17:04) That allows us to do is we have expertise with like policies and procedures to help companies get delegation. And when a lot of organizations are looking to get delegated with a payer, basically what that means is the payer says you… for example, would have delegation, they would grant it to you. But you need to work with a cvo such as medallion, we would be your sub delegate. And essentially what that means since we’re ncqa certified, is that we would pretty much do the credentialing for you. So essentially, you would hire a new provider, we create a credentialing file in three business days or less.
Dave Wallach (17:43) Your team would review it. Your team would have a committee that votes and approves somebody. And essentially that provider is able to see patients immediately. So it’s almost like instead of waiting 9,150 plus days, you have people seeing patients in literally two weeks or less. Okay? So that is something.
Heather Bogner (18:04) That we.
Dave Wallach (18:05) can help you with. It. Doesn’t happen overnight. A lot of companies come to Medina and say we want delegation. There’s. No guarantee you’re going to get it. You might get it with two payers and not all of them. Okay? Something that we can certainly talk to you about. So you can say, maybe start exploring with certain payers. Would we qualify for delegation? That might be a good starting point if they say, yes, then that could open up the conversation for us significantly in terms of value. You’re at least, you know, we can get into the numbers. You’re probably leaving millions of dollars on the table by making providers wait 90 plus days until they’re seen sending claims out. Right? Anyway, I didn’t mean to get off track, but that’s a huge.
Heather Bogner (18:47) No, I didn’t get off track at all. Yeah.
Dave Wallach (18:49) It’s a huge value proposition that we have for a lot of clients.
Heather Bogner (18:52) Yes.
Chris Jones (18:53) So we can talk. Yeah, go ahead. I was just going to say is that the case, are your providers kind of on the bench until they’re fully credentialed? Do you have any kind of backdating with any of your payers? We’ll.
Heather Bogner (19:04) backdate? Slightly recently. Well… we just have always tried to make sure that we get the 90 day 90 to 120 day notice, right? We’re hiring a new provider. They’re starting out of residency first of August. We want to get the information before the first of may, so we can get through all the credentialing process before then. But that’s been the historical behavior with what we have on the horizon that we’re envisioning that’s a whole different story. Sure. So, yeah, just thinking about getting to the 100 providers under 110, that doesn’t take much that wouldn’t take much, right?
Dave Wallach (19:50) And you might even be close. We’ve seen delegation for smaller companies. It just depends on each provider. I’m sorry, each payer, but.
Heather Bogner (19:55) Think about the great relationship that we have with anthem and how we have special contracting and that might be the first way to go with that, right? We already have this in with you. How do we flip that into this delegation thing? Okay? This is good information. Good so far? So good. Yeah. Okay.
Chris Jones (20:15) So, yeah, that’s something we can definitely dive deeper into. What would I guess if you had a magic wand, what would a perfect scenario look like for you? Obviously keeping Laura in her role, assuming not adding yet count, having a system of kind of keep everything in one place. Is there anything else that kind of sticks out as a sore thumb that you’re trying to solve for?
Heather Bogner (20:38) Yeah… obviously cost because, you know, we have to be concerned about that. And I would not… adding head count was a huge thing.
Heather Bogner (20:53) The adaptability, the flexibility, the adjustability to be able to do as much or as little as we need to depending on what happens because, you know, there’s no sure thing but death or taxes. So we don’t know how and when this growth projection will go. And I wouldn’t want us to sign up for the… cadillac when all we really need is the corolla.
Dave Wallach (21:18) Sure. So.
Chris Jones (21:21) When do you think you’ll have more insight as to what that’s going to look like?
Heather Bogner (21:29) Within the next few weeks? Okay?
Chris Jones (21:31) So pretty short.
Dave Wallach (21:32) Order here,
Chris Jones (21:34) Okay. And.
Heather Bogner (21:36) Then longer term things would probably be within the next three to six months.
Chris Jones (21:40) Gotcha. Okay. That makes sense.
Chris Jones (21:43) And, you know, part of our standard process and, you know, obviously, we’ll set up some time to take you in and show you the product, go through a demo. But then it would be, you know, kind of understanding more of what, you know, what that future state looks like. So we can work with you and build out the business case and make sure the cost justification and everything is there for you to obviously make a well informed decision on. Yeah. Okay, cool. I think, I mean, that was really helpful. So, I think that’s really all I had. Were there any other questions you had for us?
Heather Bogner (22:14) No, I think I really appreciate your time with me today and what I think I’d like to do next is to talk with a couple of other, my colleagues here and set up time for us to meet and for them to hear firsthand and maybe see, you know, a little bit of a demo so that they can put together how this will work because we’re moving forward down a path with payr advisors. We haven’t signed any sort of agreement yet, but it’s looking promising. And so I would want to be able to illustrate how this dovetails nicely with that and be able to compare and contrast you with the other vendor that I’m looking at. So a little bit more of an expansive demo and discussion about the benefits and the capabilities probably within the next, within the next two weeks.
Chris Jones (23:10) Okay. We can certainly do that pulling up the calendar. So we have an off site company meeting pretty much all next week. I think next Friday, we may have some availability. I don’t have a check counter. If you want to do something this week. We certainly have some flexibility this week, but you tell me what looks best for you?
Heather Bogner (23:30) I would think the week of the twentieth would be reasonable. Okay. We’re out all next week. Got it. We don’t quite move at speedboat speed, but it.
Chris Jones (23:42) looks like speed either.
Heather Bogner (23:45) Yeah.
Chris Jones (23:47) Gosh, week of the twentieth, I see that we have that’s our club trip. Dave’s going to be out. Josh is going to be out. I think Dave, do you know, is anybody going to be around that could fill in for josh for a demo that week? I’m sure.
Dave Wallach (23:59) We could find a very well capable solutions consultant to help out, Heather, just as Chris said, a lot of our team is going to be actually in Hawaii that week… but we could absolutely do it. Chris will be around and we have of course, some great solutions consultants. I don’t want to push things too far out. We can always go the week after, but I don’t want to wait two, three weeks well.
Heather Bogner (24:25) And one of the things that I’ll do too is enlist the help of our fantastic admin who keeps everybody’s schedules in line to make sure that we get a time that’s convenient for the CEO, the CFO and the other people who need to be involved because I can’t manage all that calendar.
Dave Wallach (24:40) Perfect. Chris. What I’ll say as we’re talking about?
Heather Bogner (24:46) What?
Dave Wallach (24:46) I’ll say as we’re just talking out loud here is, I mean, I’m up at the crack of Dawn as it is today and on hawaiian time, I’m going to be up at, I don’t even know earlier. So I would say I’m more than happy to join if we want to do like a nine o’clock start or nine 30. I mean, it’ll be really early and it won’t interfere my day. So, I’m happy to join. It’s all.
Heather Bogner (25:07) Going to depend on the other people’s schedules. Yep. Well, maybe, yeah.
Chris Jones (25:14) If you want to get some insight into that and then float some times over to me then we’ll get a calendar. Okay, that?
Heather Bogner (25:22) Sounds good. I will start working on that and we will plan to connect again at some point this month.
Chris Jones (25:28) Perfect. That sounds great. Heather. Thanks so much appreciate your time. It was good talking to you and we’ll look forward to continuing the discussion all.
Heather Bogner (25:35) Right. Thank you so much. Bye.
Chris Jones (25:37) Take care. Bye bye.