Transcript
Chris Fagan (00:00) Chris, how’s… it going? It’s going very well. How’s it going with you?
Kristine Martel (00:06) It’s good. The sun’s out. That’s a nice bonus.
Chris Fagan (00:09) There we go. There we go. I heard there was a little snow up there, oh.
Kristine Martel (00:14) Yesterday was ridiculous.
Chris Fagan (00:16) Was it? Yeah, my mom was telling me she’s down in Boston.
Kristine Martel (00:20) It hit my kids like first thing in the day. So they had, you know, mom, the flakes are real. And then, you know, by, I don’t know 10 o’clock it was snowing here and I was not happy.
Chris Fagan (00:31) I’m not happy about it. We’re coming around the corner. We’re coming around.
Kristine Martel (00:35) The corner? Yes, we are. We totally are.
Chris Fagan (00:37) Yeah, we’re coming around the corner.
Kristine Martel (00:38) Very close. Thank.
Chris Fagan (00:40) You for taking the time. Thank you for sending over that information. We appreciate it. So we got just kind of level set here a little bit. You’re still good for 30 minutes, right? Yep? Okay. So we got a little head start. Hassan’s on the call obviously. Yeah, yeah, we got a little head start with the information you gave us on the bba. There are a few pieces like I mentioned that we’ll obviously just need some more input on for us to kind of complete it. And what I was thinking is obviously we go through that today. And then after that, let’s just discuss next steps, right? How we want to go about either presenting this to the rest of the executive team. We want to go about doing a walkthrough of the platform, talking about like the nitty gritty, you know, turnaround times and the process, the workflows, all that stuff. So, we can hold that off for the last couple of minutes. But let me share my screen here.
Hassan Zahir (01:41) While you’re pulling that up then, Chris, we also thank you for sending the list over on Saturday. I think it was, so we’ve got the list. We started working through it and I’m just extremely confident in our ability to support you in those things. What I started doing was I just kind of took the image, broke it down into a checklist. We’re just kind of highlighting where we support where we need a little bit of clarification. The good news is there’s nothing on the list thus far that I’ve worked through that we don’t support. Some of those are just really like inherent in the platform. And so it’s just part of like our core offering. And then we have questions on volumes for some of the others. So when we go through this exercise today, you’ll see some of those things listed. It’s not to say those are the only things we support. It’s just how we price is like a consumption based model. And so we just want to kind of get a clear understanding or I shouldn’t even say clear, get directionally correct, if that’s fair.
Kristine Martel (02:42) Awesome. I just pulled out the stats of like things that I might have access to. But if not, I can absolutely get some information and come back.
Hassan Zahir (02:52) Okay, perfect. Awesome. And so what you can see here that Chris has up and he can start walking us through this is essentially we’ve broke it out based upon like spectrum HCP then smsc, and so kind of like focusing on the side of the business where you’re getting the providers they’re employed. They’re getting sourced to the care sites and then the management services company and what’s happening on that side of the business because even though there’s less providers, it seems like there’s just a much broader swath of services that are offered. And so we wanted to just kind of make sure we were understanding this correctly. Okay?
Chris Fagan (03:33) Yeah. So we’ll just, I think let’s give Chris if you want to take a minute and just kind of see we’ve input some numbers in here already if you want to just validate those for us and make sure we’re on the right path.
Kristine Martel (03:48) Yes. And we don’t have, if I have any nurses, it would be included in that other.
Chris Fagan (03:56) Yep, because.
Kristine Martel (03:58) We do have a couple crnas, but we bucket them with physician assistants and another title that’s completely escaping my head. So they would be included in that bucket. But we don’t have any behavioral health. Okay. Perfect.
Chris Fagan (04:14) Yeah. I think I had that in my notes from our last call. So that’s where I kind of that’s where I threw that 20 in which was the cnras and the pas and that lot. So.
Kristine Martel (04:24) The challenge on the next group is that it depends. So if I and I could send you pieces of this chart. But if you work for one of our divisions, if you work for our southern anesthesia division, you only work at Maine med. But if you work at our coastal anesthesia division, there are eight different sites that you might be privileged at. And if you work in our pathology division, it could be 14 sites. So it’s really dependent on which division you work for, that. Each division has different relationships with different facilities in the state. And.
Hassan Zahir (05:07) That was going to be our assumption there. Chris and I were talking about this. And so the hope is like, can we get to directionally correct pricing? So we can start giving ideas of like what the benefit and the value of medallion would be. And so if we, if you were comfortable with an average number that we could put there, if we say, okay, these ones would go here and there’s like one site, these ones go here and there’s eight sites.
Hassan Zahir (05:33) These ones go here and there’s 12 sites. And let’s say on average, that gets us to, you know, like we say that there’s seven sites on average, like just again trying to get directionally correct or as close to directionally correct as possible.
Kristine Martel (05:46) So they go from one to 18, but… there are one… two, three four five that are eight to 18. The largest number of providers is 106 at that number one. So I would say it’s probably like 10. Okay. As a multiple… actually number of is that, no, that’s not equal?
Kristine Martel (06:29) I’m going to use the next one for a minute. Do, do… nine plus eight plus two plus 10 plus eight plus 10 plus… yeah, 10 works. Okay, perfect. So.
Hassan Zahir (06:56) We will use 10 as that average based upon just kind of this current distribution. And, we can get to, we can get to a, another, we can get to a clearer number or… more accurate number. But, I think 10, is a great starting point for us. So we’ll say that hospital applications needed for new providers. On average, we’ll say is 10 and then the reappointments, were we’re just going to say that’s 10 as well. And that’s on a two year schedule? I’m assuming Chris?
Kristine Martel (07:31) I have absolutely no idea.
Hassan Zahir (07:33) Okay. I’ll most of the time, those reappointments to those care sites are two year schedules.
Hassan Zahir (07:38) So we’ll assume a two year schedule. We can drop a note there. Okay, Chris, that we’re assuming is a two year schedule. I’m sorry for the reappointments. Yep. And then for those providers, since they’re going to these, to your partner sites like Maine medical and the likes, you’re not doing like any credentialing of those providers internally, are you, no, you’re not doing any ongoing monitoring of those providers either like ongoing license expiration checks or anything? No.
Kristine Martel (08:09) No, we do that. You?
Hassan Zahir (08:11) Do ongoing monitoring for providers. We do. Okay. So let me modify that spreadsheet section really.
Kristine Martel (08:18) Quick, right? And we make sure like we keep track of their cmes.
Hassan Zahir (08:22) Okay. So cme tracking is part of the core offering of medallion. And so that’s what I was saying earlier, a lot of these things are part of the core offering of medallion. What about caqh maintenance? Are you performing any caqh maintenance on them?
Kristine Martel (08:39) No idea. Okay. Give me an example of what that is.
Hassan Zahir (08:43) So, they have their profiles in caqh which are normally used for like the enrollment process. And when you want caqh up to date, they have to attest to it every 120 days. You need parity between caqh and the enrollment applications, so that there’s not any issues in getting in network with, you know, the bucas, the blues unites, so on and so forth.
Kristine Martel (09:08) That really might be with the payers.
Kristine Martel (09:14) But I’m not sure. I’ll have to find that out.
Hassan Zahir (09:16) Okay. Right now, we’ll assume no for that, but we will assume that ongoing monitoring is occurring for all of the 400 asol providers.
Kristine Martel (09:28) Yep.
Hassan Zahir (09:28) Okay. So that was just the question that we wanted to verify on your side and so on the HCP side, then we’re looking at the new providers starting the completion of the applications to those care sites, getting those submitted over and then running the ongoing monitoring license expiration, like all of the sanctions checks and the likes for those providers. Yep, but no full credentialing file on those providers. No. Okay. Just wanted to make sure because they’re going to, in the application process, they’ll get credentialed when they’re going through that privileging process at the partner site, right?
Kristine Martel (10:09) At the site? Yep.
Hassan Zahir (10:10) Okay, perfect. And so I think that we’re probably aligned then with, on that side of the business, is that fair? That, that’s like the core functionality that’s happening for your HCP providers? Yes. Okay. And then now the other side is where it gets fun, right? Because this is dependent upon the contracts that are in place, the growth of the partners. And so what we did here is we anticipated growth of 50 providers. So we said 125 providers today that you’re providing services for and anticipated growth of 50. Yep. Now, this is where you are likely not to have numbers not to say you don’t but you are more likely not to have numbers on the side. And so the first one that we’re looking at is the application support for new providers for these providers. If they’re getting placed at care sites, you’re offering that service to them as well, correct? Correct? Yes. And so this one will say, okay, if there’s 50 new providers, if we’re saying growth of 50 new providers, what number is there a number we should assume on average for the number of sites these providers are going to?
Kristine Martel (11:28) I would say four.
Hassan Zahir (11:30) Okay. So this will be 50 new providers times four sites, perfect. And then for reappointments, then if we’re saying four sites, then we’re talking essentially 125 plus the growth of new providers. That gives us 175 divided by three, which is 58. So that’s like 60 providers, well, technically reappointments are every two years. So 175 that will be divided by two for reappointments versus re enrollments. So 75 75 is 150. So let’s go 85 or so by four. Okay? Because the reappointment schedule with the care site says every two years versus like the three years with the health plans. And since we’re saying the, I just want to make sure my math is right here. If we’re saying… 175 total providers when it’s all said and done, it’s 87 point five providers. So I think that 85 is like, a good number there. Is that, is that fair? Chris? Yep. Okay. And then the next one payr enrollment. So this would be new providers. And these new providers you’re doing are you, I should ask, I’m making an assumption. It depends you’re doing direct enrollment with them for some of them?
Kristine Martel (13:09) Yeah. For many of the payers, it’s their, the… revenue management system that they’re on, does a lot of that. So, if they’re working with mbms or MSN or, ventra, does you know, like, their provider does the payr enrollment?
Hassan Zahir (13:29) But if they’re not, do you do any of the payr enrollment? I,
Kristine Martel (13:33) don’t think we do for any of our clients?
Hassan Zahir (13:35) Okay. So we will pull that for now. Is it fair for us to ask you to confirm that? Yes, of course. So, we’ll pull that for now out… for payr enrollment, which becomes a question mark, which means that if you’re not doing the enrollment, then the revalidations also are out, just highlighting that those are services that we support. And then also for facilities… are there any, if you’re not doing it for the providers, are you doing it for the facilities or can we make the assumption that those same… that?
Kristine Martel (14:15) It would be done by the payr. Yep, I mean, by the, whatever they use for billing.
Hassan Zahir (14:21) Right. And so we’ll say,
Kristine Martel (14:26) but I’ll confirm that, yep.
Hassan Zahir (14:29) We’ll add a comment.
Hassan Zahir (14:42) Okay. So we’ll add that comment that you’re going to confirm that, that’s being done by the billing partners today. And then we talked about the ongoing monitoring, how you’re doing that for the I’m… sorry, for the acp side of the house today. Are you also doing the ongoing monitoring, for the managed side?
Kristine Martel (15:10) I don’t know.
Hassan Zahir (15:12) Okay. Let me find that out. Okay, right now, we have 175. We’ll add that same comment. Yep. Okay.
Hassan Zahir (15:38) And then the last piece would also be one that we would ask you to verify and that’s if the billing company is responsible or the provider, may they may ultimately say that the provider is responsible for their own caqh updates and maintenance or if the billing company is responsible for their own caqh updates and maintenance?
Kristine Martel (15:58) I feel like it’s the responsibility of the provider, but we hold their hands, okay?
Hassan Zahir (16:04) Oftentimes that’s what we see the challenge then becomes, if a provider’s caqh profile isn’t up to date, then the reappointments, I’m sorry, the revalidations and, you know, the initial enrollments fail… I will put in that it is.
Hassan Zahir (16:26) This is currently.
Hassan Zahir (16:36) We’re going to make the assumption that is a provider requirement. And I’m actually just going to pull that one off from a volume perspective unless we hear differently from you. Okay? And so that gets us to an understanding of what we were understanding was occurring. A lot of the other items that you shared with us from the document as far as what is being what you’re providing. So like onboarding support the orientation, the compliance portions. All of those are generally included with medallion, core expirables management is included within the core platform. The tracking of facilities and site locations is included in the core platform. The offboarding is included in the core platform. Medallion functions as a source of truth. Any practitioner name changes we validate against npez for mpi numbers. Obviously, this is the management database. We can support the roster reconciliation either through custom rosters to the provider. I’m sorry to the payer’s requirements or we can generate rosters if that has to occur. And so everything else that I feel like we have kind of like a volume based association we discussed today. We will go through that document in detail. There’s a couple of places where we will need additional clarification for example, on the sheet you had like the quality review. I’m sorry, maybe it was the case logs I’ve got to go back, provide case laws clarification and what the expectation, is there? I’m sorry, clarification on the case logs and providing case logs. If the expectation are those stored in the system. Is there something that needs to happen with those? So I’m going to put together that list, Chris, I’m not going to ask you now. Oh, beautiful. Okay. We’ve only got, we’ve only got 10 minutes there’s. No way we would get through the entire list. So I would rather put together the list of where we have questions, kind of highlight what medallion does today and see if that checks the box for those or if there’s something some additional functionality that needs to be done. And so my goal is to start working on that and get that over to you by the end of the week, I think as we start putting, this initial bva together, we’ll be able to give you an idea of like, okay, we think with the team that you have today to be able to do all this work, you probably would only need a team of X as opposed to, you know, the size of the team you have today. So Chris and I will work on that. And then Chris, I’ll hand it to you for next steps as far as like. Kind of in parallel if there’s anything else that we want to start tackling, yeah?
Chris Fagan (19:42) Perfect. Does that sound okay as far as getting that to you by the end of the week? Yeah. So we’ll work on that. We’ll get you that by Friday. So, the way that kind of like I think I was talking to you about this a little bit last time, right? We get, we start with this kind of lightweight bva and start to develop, you know, what we call a business case which you’re fully aware of, right? The next step on that is typically we’ll bring in whoever else needs to be involved unless it’s just you from the executive standpoint. And once this is finished and we present that to them. And then within that timeframe, like let’s say we schedule that out for two weeks from today or something, right? Within that timeframe, we will do a deep dive walkthrough scoping session with your technical team and you of course being involved in that as well. And then that’s kind of those are kind of the two points that I wanted to make sure we kind of were in agreement on today. Does that sound fair as far as kind of like the next steps in the process technical? Meaning it? Yeah. So scheduling that like let us just kind of give us a little bit of information if you wouldn’t mind on kind of who needs to be involved on both the executive leadership side of things to kind of sign off on this bva in the business case that we’ll present. And then also who needs to be involved on the technical side of things from your standpoint, right? From your thought on us kind of giving a walkthrough of the platform number one, but also really diving deep into what the process and the workflows look like on both the HCP and the smsc sides?
Hassan Zahir (21:25) And Chris, really what we’re trying to accomplish here is understanding like, hey, are you using the same instance today for both sides of the business or are there separate instances of your current platform for both sides of the business? What does that flow look like? How is your team split up? We don’t necessarily need to meet with those individuals as much as we need to know the process. Sometimes meeting with those individuals is not… ideal because they can see this as a threat and they see automation. And they say Chris is trying to get rid of us. It’s more so of like one technically, do we need to integrate with other systems? Does this data need to go other places? Are there reports coming out of your current system that we would need to be able to mimic and push to systems? Is there data coming into your current system that we would need to be able to put into medallion? And then kind of like a day in the life. New provider starts on the HCP side, what’s like day one? Do they come from like an applicant tracking system? How do you start the process of getting them into the database so that the applications can be completed? Medallion, automates, these things. We’ll auto, submit the application. We’ll map from the provider profile. We’ll pull down from caqh, and so on the HCP side, it’s probably a lot more straightforward when it comes to the services that you’re offering on like the smsc side, then it’s kind of like, okay, how are you onboarding these providers? And what is step one? And how are we capturing the information? And medallion has a portal? And so, it’s kind of like more of that. And I would almost say if you have any workflow diagrams or anything that’s used to train new employees when they start. That could also be beneficial. And check those boxes. We just want to make sure to Chris’s point that the business stuff makes sense. But also we’re doing due diligence on what it would look like for a potential future implementation and integration so that can go as smooth as possible.
Chris Fagan (23:39) Okay. And they’re both, they’re tied together too, right? Right? Having that information on the workflows is going to help us create a better and a stronger business case for us eventually presenting to the executive to all of the executives including yourself.
Kristine Martel (23:52) Yep. Yeah. So the, your point is well taken, technical meaning expertise in this area is definitely the people who would be immediately skeptical and questioning. So… I need to process that one. On the exec side, I mentioned that we were on, we meet every Monday morning. I mentioned that we were having a follow up this week and that I might need, I need everybody to think about who might want to be around that table when we have the next connect. So Monday morning, I’ll ask that question. I ask them all to just process it and I don’t know. My guess is, it will likely be my coo, okay?
Chris Fagan (24:36) Okay. Just for my own edification, what’s the name of your coo? I can probably find. I can probably find it out. No.
Kristine Martel (24:43) No, that’s okay. First name’s Leslie, last name’s weeks.
Hassan Zahir (24:47) Leslie weeks? Perfect. Awesome.
Kristine Martel (24:50) And, she is unfortunately for our executive team right now. She’s also our historian because the rest of us have been here for a very short time. So she definitely knows a lot about things that you might not even expect her to just because of her history here. And.
Chris Fagan (25:09) When let’s say perfect world when it comes to budget approval, is that, who is eventual going to be the sign off?
Kristine Martel (25:17) Official budget approval is our board? Because we are a physician owned. So the, we would make recommendations to them. But any big things like this would have to go through the board. So.
Chris Fagan (25:30) It’s safe to say that we may have to present to the board at some point.
Kristine Martel (25:36) Interesting question. No idea if it would actually be that you had to or if it was us. I haven’t been here for something like this to happen yet. So I don’t know if we typically bring outside vendors in or we vetted. It. This is what we think is the, you know, a great idea. And here’s the, you know, return and they believe us. It is a group of physicians who know from their purview what they know. So I don’t know we’re also thinking about looking at something very different on the HR side. And I asked that question to my CEO about like how deep do we have to go with the docs on this or is this a business decision? Yeah. So I think we’re both learning as we go, okay?
Chris Fagan (26:24) Okay. Just to keep in the back of your mind, we’ve done that before we’ve made those presentations before. So it’s something we’re more than comfortable doing.
Hassan Zahir (26:32) Yeah, that’s.
Kristine Martel (26:33) great for what?
Hassan Zahir (26:34) It’s worth. Chris and I both are partnering with a gentleman here named Dave wallach and we were a part of I’m not sure if central Ohio primary care. They’re the largest physician owned primary care group in the country. Oh, wow. We’ve been through these sorts of exercises that’s a good one. And maybe we kind of keep them in our back pocket as a potential reference call for you in the future. But we have supported organizations who function in a similar way. Like I said, central Ohio primary care jumps to mind as one that both Chris and I supported with Dave. And so happy to make those introductions. You know, if the time calls for it.
Kristine Martel (27:15) That sounds good. And my guess is that we don’t have a ton of documentation because we are currently in the process of onboarding somebody new and they’re all here on not all of them but a few of them. And tomorrow everybody is here on site and I think that’s due to the lack of documentation that we have because it would be very easy for her to learn from her home in Boston if we had better documentation.
Chris Fagan (27:40) That’s right? Could be a plus for medallion on some levels.
Kristine Martel (27:45) Yeah, 100 percent.
Chris Fagan (27:47) Okay. So how about this? Let’s make this easy. We will get you the information that we so just kind of level setting on next steps. Yep, Hassan will put together the questions that from the sheet that you sent over. I know that you there’s also some follow up, that, you, know, I saw you jotting it down. We’ll put those in an email to make sure everything’s written, everything’s in an email in an email thread to reference. We’ll get, we’ll get you this bva by Friday, ideally. And then like you said, you’re having a couple of conversations on Monday, why don’t you and I just do a quick 15 minute on Monday or Tuesday and then we, you and I can discuss kind of how that went, how the bva landed and we can discuss, you know, ideal next steps for the executive team, the technicals, the workflows, all that stuff, give you a little time to kind of go over it.
Kristine Martel (28:41) Yeah, sometime after two.
Chris Fagan (28:43) Monday or Tuesday.
Kristine Martel (28:45) Monday, Tuesday’s, board meeting day.
Chris Fagan (28:48) Tuesday’s board meeting day after two. Let me just double check here. I didn’t put this in my calendar yet. I’m flying on Tuesday. Give me one second. I’m flying. I land at 250. Okay, I could do a little later in the afternoon. How about… can we do four 30? Perfect? All right. I will send you, I’ll send you a calendar invite right when we get off this call for four 30 eastern on Monday… that.
Kristine Martel (29:26) Sounds good awesome.
Chris Fagan (29:28) And if there’s anything changes, I mean, we know how flights can be especially now. So if anything changes, I’ll make sure I reach out directly to you all.
Kristine Martel (29:35) Right. You got it. No problem. Thank you so much for your time today.
Chris Fagan (29:38) Thank you. Thanks, Chris. Talk soon, take.
Kristine Martel (29:40) Care. Yep, bye bye cheers.