Transcript
Kristi Toby (00:00) good morning, Annette.
Annette Craig (00:16) Sorry. Can you hear me now?
Kristi Toby (00:18) Yes, I can. How are you? Good.
Annette Craig (00:20) How are you? I’m.
Kristi Toby (00:21) doing well. My days have been thrown off. My children are on spring break this week. And so like every day is just, you know, the weekend. And so I was like, wait, what is today? And I’ve been off all day, but it’s Wednesday. We’re halfway there.
Annette Craig (00:34) I know we are hump day, so.
Kristi Toby (00:37) Absolutely. Thank you so much for joining this morning. I believe we’re waiting on Dave and also my direct manager, Genevieve who was on our kickoff call as well, will be joining us before we get started.
Annette Craig (00:54) I’m just going to ping David to remind him.
Kristi Toby (00:57) Okay.
Kristi Toby (01:25) There’s David.
Kristi Toby (01:33) Good morning, David.
Kristi Toby (01:41) Morning. How you doing?
David Moreno (01:45) That’s a loaded question.
Kristi Toby (01:47) Oh, okay. Well, hopefully you’re overall, you’re doing well.
David Moreno (01:54) I’m good with that.
Annette Craig (01:56) And how hot is it at your house? It’s.
David Moreno (01:59) actually in the sixties. Oh, we had a little cold front and rain. So it’s cooled off. It’s like dark today, but, yeah.
Kristi Toby (02:12) I’m based in Atlanta and it’s sunny, but at the temperatures, it feels like fall?
David Moreno (02:18) Yeah, that’s how it is here. It feels like fall today.
Annette Craig (02:23) And we woke up to 20 degrees this morning. Oh.
Kristi Toby (02:26) Wow, you’re in Philly, right?
Annette Craig (02:28) No, Wilkes barre, Pennsylvania, and they’re hoping this is the last of the cold snap because we’ve been like one day at 70 the next day, like at 45, so, they’re hoping this is the last of the up and down. Yeah, it’s beautiful. I mean, the sun’s shining but it was very clear and cold last night.
Kristi Toby (02:47) Yeah. Well, hopefully this weather stabilizes, and we have a pleasant summer because so far in 20 26, I feel like it has been all over the place, which is why nobody can stay healthy. Yep. Awesome. Well, there is. , Jen. Hey.
David Moreno (03:02) Guys. Sorry about that. I’m a couple minutes late. How’s everyone doing good?
Kristi Toby (03:07) Well, David said it’s a loaded question. So, maybe we need to reframe. Yeah.
David Moreno (03:11) I’m a millennial, I’m a millennial guys like, we just, we all got here too early. Oh, no worries. Hopefully, it’s a quick Wednesday then. Yeah, I mean, I haven’t so I haven’t well, I think she’s 21 now. So what a rough night. So today’s, going to be rough for me. Oh man. Well.
Kristi Toby (03:34) Awesome. Well, I appreciate each of you joining again. I’m Christy. So I’ll be your dedicated account manager throughout the partnership with medallion. And so today will be the first of an executive series that we will kick off because I do think it’s important for us to all level set and make sure we’re all in line on the overall strategy for the partnership, right? And not just those tactical aspects. And so today, I really just want to frame how we can best work together. Make sure if there’s any initial questions or scenarios that we should consider as the team goes through implementation. And of course, with Jen and myself both on the line, you have an opportunity to ask any questions or do any discovery that we need to do today to set us up for success. Was there anything else more specifically you wanted to get out of the time today?
David Moreno (04:20) No introductions, right? Is top priority for me on this call. Understanding who you guys are, what you can help us with. And I guess which would lead into the next question and Annette help me here. It seems like we’ve already hit a stumbling speed bump on our implementation scope wise, correct? Annette regarding clinics and payer enrollments?
Annette Craig (04:49) Well, I don’t know if we’ve hit a well. Yeah. So for delegated payer, credentialing, is that what you’re talking about?
David Moreno (04:56) I don’t know it’s very difficult. I’m an it consultant.
Annette Craig (05:01) Yeah. So I did ask for, and I don’t know Christy if you’re the right one. I reached out to Mallory this morning because yesterday, on our weekly implementation, Patty Kane, last week, I met with her and she’s the CEO over our physician practices and we definitely need delegated payer credentialing and as we had that with CHS, so they normally got a roster at the end of the month, the payers and so they could get checks out to us and stuff. So she said that is definitely a must and I know that’s not in the current contract. So I did reach out to Mallory this morning because she told me yesterday on the weekly call that it would be someone different who needs to handle and add on to the contract.
Annette Craig (05:43) So I just asked for a name so that if I needed to get David obviously and Patty on a call to add this extension on because she’s saying that is definitely a must especially to get paid timely and stuff. And I know some of the payers have reached out already and said, are you going to continue with delegated credentialing? Yeah.
Kristi Toby (06:04) Yep. That is a great question. And thank you for calling that out. So Jen and myself are going to be that dream team for you. So just to level set on roles and responsibilities. So while you very much have Mallory as an avenue of support, she’s your sort of solutions consultant, she knows the ins and outs of the program. And so as you’re going through implementation, she has that deep technical expertise. But anytime you have overall expertise, partnership questions, commercial questions about need to add this on or we need to true up or things to that effect that’s when you’ll contact me as well and I’ll be able to route you in the right direction. Okay? Great. So we can definitely speak to that. That was something that both Jen and I wanted to bring up during the call today, that very thing. And so thank you for calling that out. But is that helpful just to, so any questions that you have don’t hesitate to reach out to me and if I don’t have technical expertise, I’ll make sure you get routed to the appropriate person absolutely.
Annette Craig (06:56) Thank you.
Kristi Toby (06:57) Of course. And then the presentation that we’re going through today, I can re, add the resources slide as well. That was in the implementation kickoff just so you have that as well as a reminder if you ever need it. But long story short, contact me and then I can route you in the right way.
Annette Craig (07:12) Okay. Thank you. Okay. So.
Kristi Toby (07:14) I’ll send this over after the call as well. So again just align very quickly on strategic priorities. I know we just aligned on it during the kickoff call, but just it’ll always be the framework for which we base our conversation. So sometimes when we do get into those technical things or glitches, right? We can sort of level up to make sure that we’re all aligned and working towards the same goal. To your point, we’ll make sure the program is exactly what you need it to be as we’re going through this implementation process. So that way if there are ancillary services that you need or there was something that was missed in the initial contract, right? We can make sure you have what you need moving forward. So as you’re going through the implementation piece, you’re trained on all the aspects of the platform that you need to set you up for success. We’ll show you when you are live, what the data and insights will look like during these conversations. Because I know throughout the sales process, having that visibility and access to that real time reporting was critical. And so again, we’ll make sure that during the conversations that you and I have, you’re getting all the data points that you want, we’re tracking those. And then we’ll make sure we’re aligned on next steps. Anything different than what you’ve already mentioned?
Annette Craig (08:23) Nope, not on my end. So.
Kristi Toby (08:25) Again, these are just the strategic objectives that we all aligned on during the kickoff call. And so accelerating revenue, right? Making sure we’re getting you all to par, much faster the visibility and analytics that I just spoke to. Once you’re live, we’ll make sure you’re in the portal and you understand exactly where you can go and track all the insights as to how the team is consuming what you’ve purchased thus far. Of course, the overall goal is reducing those operational costs by streamlining and automating your credentialing process as much as possible. And then as the team continues to grow, right? And have this goal of scaling from three to 10 hospitals over the next several years, right? Making sure that all the processes and systems that you have in place are easy to rinse and repeat. Is that still accurate?
Annette Craig (09:11) Okay.
Kristi Toby (09:13) Awesome. So then let’s dive in a bit on the sort of program overview to make sure tenor has what they need for success. And so the core solution, right? Is going to be that provider data management piece that’s the medallion core where the providers have access to the platform and you are able to go through the credentialing process and making sure they’re all onboarded. And you can sort of track the various solutions that you have overall. And then you do have the sanction monitoring so that’s going to do those continuous checks for Sam, oig, medicare, opt out, NC, MP DB. Sorry. And so that’s the one that you have to date. And then there’s also two other versions of monitoring that I just want to make sure you’re aware of. And so there’s the ncqa compliant monitoring and there’s the comprehensive monitoring that is available as well. Because again, not trying to push you in any direction but just want to make sure you understand the different levels of the different types of checks. But I think this was something that was brought up during one of the prior calls that we were on. And I think you mentioned that the monitoring that you had presently aligned with the checks that you have in place currently is that accurate. Okay? All right. And so then of course, you also have the payor enrollments and revalidations, which of course, is automating the application process, payor follow ups that we’re facilitating and just making sure that you’re aware of upcoming renewals and things to that effect.
Kristi Toby (10:40) And then right now you have the Jc credentialing so that’s going to help meet the standards that you have to date. But I think there is some interest and Jen feel free to jump in here as far as the ncqa credentialing and what’s actually needed for that. Yeah.
Genevieve Seney (10:57) I think that’s exactly what you were just touching on before, that will be a requirement for your team. And so that is the piece I guess that wasn’t included in the initial scoping. So I think what would be helpful for Christy and I today is to talk through that a little bit more and what we would need to basically understand so that we could kind of scope this out for you is how many providers that would be. I think you guys have Christy correct me if I’m wrong 950 today in contact. And so like, are we looking at all 950 for credentialing? Yeah, yeah.
David Moreno (11:31) It’s the employed physicians, right? Annette.
Annette Craig (11:33) Well, wait, so are we talking payr? So Genevieve, are we talking payr credentialing or who needs to be medical staff credentialed?
Genevieve Seney (11:43) So, I guess let me take a step back. What we’re talking about. So, you guys have payr enrollment data already in your contract, so that’s obviously straight applications to payr, what we’re referencing is the cvo. So the delegated contracts providers?
Annette Craig (12:01) Okay. So let me just, and I’m just going to ask for clarification. So, the delegated, so not the delegated payr, credentialing, you’re talking about medical staff credentialing for the hospital… two?
Genevieve Seney (12:14) Different things. So, for the hospital yep, so for hospital, you guys have, obviously, so we have tjc, we also have, I don’t think it’s on this slide, just straight hospital privileging or it’s right there privileging. So that’s your hospital application. So to get privileging at the hospital, and then cvo and cqa, which would be what you’re saying, the rosters every month, you have a roster of your providers that are, yeah.
Annette Craig (12:39) So that would be 950, right? So staff to be tjc credentialed would be 950 between the three entities.
Genevieve Seney (12:53) Okay. And then 950 for the delegated cred, and so for the wait.
David Moreno (12:59) Hold on. So, we gotta get some clarification, because if Patty Kane is asking, Patty Kane, oversees the physician groups that are for payouts employed physician.
Kristi Toby (13:10) Yes.
David Moreno (13:11) Right? But there’s interhealth or commonwealth, right? Does not employ 950 physicians.
Annette Craig (13:18) Correct. They do not.
David Moreno (13:20) So, why would they do?
Annette Craig (13:21) Why would?
Kristi Toby (13:22) We, well.
Annette Craig (13:23) So, and that’s why I’m trying to, so, for payor delegated credentialing, we have about 150 employed that are payor credentialed in the network, right? You learned Wilkes barre and scranton. So about 150, okay?
David Moreno (13:41) But if they’re already part of the medical staff credentialing and part of the payor enrollment counts, is this a separate line item that we have to include?
Genevieve Seney (13:53) So, no… great question. So, the 150 is already included, the 950. So you’re not adding provider seats basically. So you don’t need to worry about adding any more provider count. What we would add is 150 ncqa credentialing files. So that’s what you would need is the actual ncqa verified files and we would add 150 providers for a monthly roster.
David Moreno (14:19) And what are we looking at in terms of dollars? Yeah.
Genevieve Seney (14:23) So what we’ll have to do is take a look at your contract today in terms of what you had for cred, tjc in terms of your contract, the one thing I’m starting to think about too is sanction monitoring. I’d have to, it sounds like we might need to chat with whoever runs the delegated contracts because for ncqa, you would need ncqa compliant monitoring if you’re talking ncqa credentialing files. And so there’s a few different things David that you would likely need to add on. But obviously, we’re going to work within your contract and, you know, scope what would need to be additional. And so we don’t want to give you like we’re not going to give you like full unit pricing. We’re going to look at what you purchased today and come back with a proposal of what you need.
David Moreno (15:04) So, just so you know, David wallach, he told me anything we added in scope was going to be free after we signed. I’d make him, I’d make him live up to that promise… and.
Annette Craig (15:16) It might, you know, it might be 100 docs, not 100. Patty would have the exact number obviously. But because then again here’s, the other caveat. Oh, no, no, it won’t apply. I’m just thinking mid level providers, not all insurance payers recognize them. Yeah. So that’s the other caveat for the state of pa, yeah, they have to get billed under their supervising physician.
David Moreno (15:42) Right. Oh, I think Annette, what’s important here is if you can connect Betty Kane and everybody at vidalian together, let’s talk through this. I want to make sure that we truly need this thing like it might be that we already are doing some level of it. It seems like because she didn’t know what was going on. There may be some confusion. I just want to make sure everybody talks and let’s hash this out. Yeah, the.
Genevieve Seney (16:09) other thing we’d want to know is how many actual delegated rosters you have because we would obviously create those rosters as well. So there’s just a few other questions. Sounds like maybe we would need to regroup. It would just be Christy and myself and whoever else would need them.
Annette Craig (16:23) Yeah. So for my clarification, the cvo and cqa credentialing on this bullet point that needs to be done, anybody who needs to be pay or credentialed?
Genevieve Seney (16:35) Anyone delegated pay or credentialed?
Annette Craig (16:37) Delegated pay or credentialed? Okay?
Genevieve Seney (16:38) But, to your, to David’s point, and your point, you might, these folks, my 150 might have already been credentialed this year and they don’t need it for another two years, so or three years. So we just need to, yeah.
Kristi Toby (16:50) All right.
Genevieve Seney (16:52) The only thing I would say too is that if you’re if you guys are, you know, it just depends if you’re manually creating rosters, if you’re creating rosters with another solution, if you want all the data to live in, medallion things like add change, you would still need on a monthly basis. So, if you add a new provider, changes their group enrollment their address, like things like that, those rosters do require monthly changes. It’s like demo updates. Almost. So again, this is all things we can talk through and see what you truly might need from the platform. And.
Annette Craig (17:25) So if we had a provider that was already credentialed at five clinic, five different clinic locations.
Annette Craig (17:30) And in two months, we decided we’re sending him to an additional one that would be considered a change then, is that correct?
Genevieve Seney (17:40) Yeah. And it all depends. It actually will depend on your contracts. So with certain payers, they might require that they might not, it just depends on the roster itself. So certain ones, you might have a national contract where you don’t need to do that, it’s just, it’s going to vary depending on your contracts.
Annette Craig (17:55) Okay. Yep. I’ll definitely get Patty Kane in touch with you all. Okay? And.
Genevieve Seney (18:00) What I’m sorry, just so we’re clear Patty Kane, which group is she with?
Annette Craig (18:05) So, she is the CEO over the employed physician network here in Wilkes barre and scranton. Got it. All right. That’s.
Genevieve Seney (18:13) helpful. So, yeah, we’re definitely happy to do another session with her and talk through what’s needed and go from there. Okay. I think maybe the only other thing Christy on this one is, I know we briefly mentioned licensing. I don’t know if that’s something we wanted to talk through as well.
Kristi Toby (18:30) Yeah, no, we.
Annette Craig (18:32) Don’t and I will tell you this because I know it’s been on our go live. So as far as the licenses for any of the providers currently right now, they all renew their own license, we don’t do that for them because I do know medallion said that would be an extra fee if we wanted you to renew their deas or their medical license.
Annette Craig (18:52) But everyone in the market here and I know down at Sharon regional as well, the providers go ahead and renew the licensing themselves.
David Moreno (19:00) Perfect. Okay.
Kristi Toby (19:02) Awesome. Hopefully this is helpful. We just like to really make sure you have an overview of everything that’s available. So as we think about the strategy, we can make sure that you have what you need. So there’s not these points and times throughout the course of the year, right? Where we’re like, well this came up and we need this as well. So we’ll definitely get the call scheduled with Patty Kane and yourself and make sure we understand what actually is needed with the ncqa credentialing and we’ll move forward from there once we have a need, and then understand what the volumes are, and we can draft up a proposal for that if needed. Any other questions or anything else that stands out on this particular slide?
Annette Craig (19:41) Nope, not for me.
Kristi Toby (19:42) Okay. Great conversation there. All right. And then this is just a level set on where we are in the implementation phases. I know that’s something that obviously you’re working with, you know, Brandon and the larger team on, but this is just helpful again and we can use our executive touch points on a monthly basis. If there is any positive feedback that’s happening in those. Of course, we always like to give the shout outs to the team for something that’s being managed well, but of course, if there are any areas of concern or points that you want to bring up for clarification or escalation to Jenner myself. We can use these executive touch points as well to regroup on any implementation needs.
Annette Craig (20:20) Yeah. Right now, I just think it’s getting the data into the spreadsheet. So, yeah, that’s.
Kristi Toby (20:27) the largest part of the heavy pool. And then once, you know, we kind of get over that hump, then things start to move a little bit more swiftly. So, I know those calls are scheduled and I’ll try to join those as much as possible with my schedule but very much so, Brandon and Mallory sort of lead the ins and outs of that piece, but you’ll certainly see me pop in and out as I can. All right. And then here’s an example of the data that we report on during these standard touch points. And so we want to just understand from you if these are helpful and if there’s anything in addition that you would like to see during our touch points. And so what we report on are the enrollments that were completed, month over month, those that were requested against processing and those needing follow up. And then I know a big point of concern for a lot of our customers is understanding from requested to complete, what does that look like? And how are we measuring against those expectations, the turnaround time as well against the number of enrollments that are pending? And then the average like task age. So we’re making sure we’re being very streamlined and managing that task management function in a timely way, whether that’s on medallion side or whether that’s the tenor health side or those that you have internally. So these are sort of the data points that you can look forward to as it relates to the various solutions that you have in place. And then of course, we’ll call out any new product enhancements or updates on the medallion side that would be helpful for you to be aware of during these as well? Is there anything missing that you can think of Annette from your prior solution or otherwise that would be helpful for us to report on?
Annette Craig (22:02) No, I think this covers it right now.
Kristi Toby (22:05) Okay. And we can certainly iterate as we move forward as well. If you see that there’s something else. Okay. Yeah.
Genevieve Seney (22:13) I’d say the last piece too for David and Annette, like if there’s anything internally that you guys are benchmarking for success for the program, always like to be aware of that in terms of what data we can sort of pair with that for medallion and for both of us as we move towards or evolve the partnership. So as Christy mentioned, like definitely want to be collaborative here. And yeah, give you guys the data you need. And I.
Annette Craig (22:37) do have one question. So because Wilkes barre and scranton are new to a cvo, so as far as on the ground for, because we do have one person right now that does payer credentialing, it seems like medallion will monitor and follow up until the provider is fully credentialed with whatever plan medicaid, medicare, you know, Aetna… what resources on the ground are needed for payer credentialing once medallion goes live.
Genevieve Seney (23:08) Yeah. So, and obviously, Christy can chime in here as well. I’d say like it’s what we kind of require, right? From like a partnership standpoint is going to be mainly the provider engagement, or if you have all provider data, great from our partnership, the times we see the most success is when providers understand what medallion is, understand what data is needed to complete their enrollments or to complete their credentialing. And so, whether that is like sort of a credentialing folks you have that do work with the providers to get that data in the platform or are familiar with your payer contracts. So they know the group enrollment data, they know, sort of what contracts you have and how to submit the requests. So like, you know, if you’re submitting a request for Aetna medicaid, and you actually don’t enroll with Aetna medicaid, right? Like we are processing the requests as you submit them. So, I’d say like that’s the person you’d want in seat for actually submitting the requests, tracking if we need an additional document, who is going to be able to be that point person there. So it varies organization to organization, but I’d say like that’s a good maybe way to think about it in terms of a starting point.
Annette Craig (24:19) Okay. Thank you.
Kristi Toby (24:22) Okay. Any other questions?
Kristi Toby (24:29) All right. So then once we are live and we are sort of rolling with the partnership, this is another data point that we like to share understanding the commercial piece and how we are consuming the volumes that you have presently. Because again, we also believe in no surprises. And so once you’re live, we understand the number of purchase SKUs compared to those that are being consumed. So we can always stay abreast of any upcoming volumes that we have fully consumed and the need to make adjustments for amendments and things like that if we were to go over it. But also understanding in providing that flexibility that you do have that SKU flexibility in your contract such that for the solutions that you have today, maybe you overconsume a medallion core, right? But we are under consuming in payroll enrollments, understanding that there won’t necessarily be another amendment necessary for the payer enrollments because we’re going to pull from where you might have under consumed in another area. And so we’ll just keep track of this on a monthly basis to understand what you’ve consumed, how we’re measuring against the available dollars still in the contract term. And also if it gets to a point where you need to pull from another contract year, you have flexibility in doing that as well.
Kristi Toby (25:47) Any questions or comments on that. Is that very straightforward? Hopefully. Okay. And then as far as the next step, then we like to at least start with having a monthly touch point for us to review this data. Again, make sure we have that session for any collaboration on implementations or product roadmap, updates things like that from the medallion side.
Kristi Toby (26:09) So does this particular time that we have scheduled today? Would it be helpful to just make this a monthly cadence or is there a better date and time that would work better for that?
Annette Craig (26:20) It’s fine with me. I don’t know what David has on his schedule. Fine with me?
Genevieve Seney (26:25) Monthly is fine for me?
Kristi Toby (26:27) This is a good time. Okay. Perfect. Okay. So I will update this meeting, invite to be our monthly cadence touch point. And then as things progress if we need to move it or change it, we can do so. And then of course, keep attending the implementation calls.
Kristi Toby (26:42) I’ll try to join as much as possible. And then I know we also discussed potentially setting up time with Patty to make sure we’re on the same page with the needs for the delegated payer enrollments. Is that something that you will facilitate Annette? Or would you like to loop me in to do the calendaring? So.
Annette Craig (26:59) Yep. I’ll send an email after this to both of you and with Patty on it. And then if you can get something scheduled, yeah. Okay.
Kristi Toby (27:09) Absolutely. So, I will send you this presentation that we just walked through. You have our contact information, any needs that arise, don’t hesitate to reach out. And otherwise, I, you know, are there any other questions from the team? I don’t have any, anything we’ve missed, Jen? No.
Genevieve Seney (27:24) I think this is great again as we sort of iterate these monthly sessions. Like we said, if there’s any data you guys need to report out on internally, we can always kind of shift and migrate as needed. But, yeah, excited to meet you all and continue the partnership.
Kristi Toby (27:40) All right. Well, thanks, everyone. Have a great Wednesday. Thanks.
Genevieve Seney (27:43) Guys. Take care.