Transcript
Peter Bosworth (00:00) bye John.
Jon (00:05) Hey, Peter.
Peter Bosworth (00:07) Hi, how are you?
Jon (00:09) Hey, good. How are you?
Peter Bosworth (00:11) I’m well, thanks doing well. Yeah.
Jon (00:14) Sorry, it, you know, it asks you to turn that stuff on ahead of a call. And then when you get on the call, it turns it back off. Anyways, it’s like just my camera and mic, you know, it’s like when you’re waiting to get in, it’s like, hey, I’m going to turn my camera and mic on. Then it starts meeting, turns them off anyways. I,
Peter Bosworth (00:31) know, for some reason my meetings, I don’t know what setting I have, but everyone starts out muted.
Jon (00:37) You know what it might be? It might be because of the recording. I think it’s because it’s alerting you to the recording. It kind of their way of confirming it. Again, it shuts them down. Yeah, that’s.
Peter Bosworth (00:47) probably it. I’ve never thought about that. That is probably it. Awesome. Well, thanks for jumping on no.
Jon (00:56) Thank you. Yeah, we so really what this is, I’m sorry, Peter, give me one quick second here. I just want to plug my computer in. Sorry about that. Really. What it’s about is so, you know, there was someone else from the company.
Jon (01:18) When we had initially signed up, James chigano, I don’t know if you had any interaction with him or if you had met him prior, I didn’t think so. But he basically got everything set up. I was, I participated in a few calls… because I was, you know, I was concerned with just getting all the information, correct, number of providers, you know, are we going to be able to do nurses and case managers as well as nurse practitioners and doctors. And, you know, all the different people under our umbrella. So, one of the discrepancies or one of the issues was I had thought initially that those case managers and nurses… and when I say nurses, I mean, like an RN, not a nurse practitioner because we work with medicaid in Ohio and we actually bill under RNS, which is, you know, not typical.
Peter Bosworth (02:27) Right.
Jon (02:28) So, and my understanding initially was that because they don’t have a caqh, you know, there’s credentialing required by the state but they don’t have a caqh. So, they’re not counted like a nurse practitioner or a doctor would be because we had during a training call with Sandhya and Connor, is it Connor?
Jon (02:57) You know, it kind of it came up that, hey, you know, you guys signed up for 50 providers at least initially. And then we had explained kind of the growth curve and what we thought it looked like anticipating. And then during the call, it’s like, well, wait a minute. One of our practices alone has 70 because just one practice, midohio has 70 because they have all these case managers and nurses as well as docs and nurse practitioners and therapists.
Peter Bosworth (03:36) Right then.
Jon (03:38) Problem number two was I was under the assumption that the 10 management… credits for the caqh that we have in our agreement?
Peter Bosworth (03:53) I had.
Jon (03:56) No clue. It was only 10. I thought part of the service was to, you know, like once someone gets connected to you guys, all the information gets in, I thought that there was ongoing management and I found out from Connor, it was only 10. So what I’m and this may not be your department but, and just let me know if it’s not that’s fine. But one of the things now that I’m struggling with my team is they’re like, you know, nobody’s got the bandwidth to manage this and it’s been truthfully it’s been a struggle just even, you know, 70 providers with people that already have existing roles and responsibilities getting everything in. So I wanted to see, you know, if we’re going from 50, let’s say to 100 immediately. What does that cost delta look like? And then if we need management for everybody and not just the 10 that came with the package, let’s say what… does that look like too?
Peter Bosworth (05:17) Okay. Yeah, absolutely. And I can definitely the right person to talk through all of this with in terms of the number of provider seats that… is correct. So RNS and case managers would count as a provider seat because they are occupying a place on the platform and restoring their data. The other thing is… you actually have 70 instead of 50, so that’s a little bit of a.
Jon (05:54) Little better.
Peter Bosworth (05:54) Yeah, a little better. So, yeah, 70 and then, but correct, you do have the 10 caqh management quantities. So we would need to up that and what I would need in order to like properly speak to the delta in cost, I would just need volumes for each of these items. So the number of additional providers beyond 70. And then the other thing is that you have like ongoing monitoring in your contract, which pretty much every one of our customers does. And so the ongoing monitoring number automatically needs to match the number of providers that are in the platform because we are unlike caqh management, we can’t we don’t like opt in or opt out specific providers. We’re just running those checks for all the providers. So, yeah, sorry, go ahead.
Jon (06:54) What’s the difference then? I don’t think I’m understanding then the difference between ongoing management or I’m sorry, monitoring versus caqh management?
Peter Bosworth (07:08) Sure. So, just here’s your agreement just for context. But yep, these are different SKUs, and so caqh management is our team going in and reattesting your provider’s profile in caqh for them and then updating any information based on what’s in medallion.
Jon (07:36) And then, yep, that’s the one I’m going to need a minimum of, well, no, I mean, if it’s really supposed to be done as often as it is, because… that might be every, what? 30 days or I?
Peter Bosworth (07:52) Believe it’s 120.
Jon (07:55) 120 days. Yeah. Okay. So if it’s every 120 days and I have let’s just call it 70 providers in Ohio and 30 providers in the rest of the country right now, you know? So that number would have to go from 10 to 100.
Peter Bosworth (08:19) So 90 additional. Yeah. Are those? And then sorry, just to finish comprehensive monitoring, is our team running sanctions? Sorry, excuse me, sanctions checks. So, Sam, oig, npdb medicare opt out, medicaid, exclusions, death, master ofac, all of these different verifications. We’re running in the background to ensure that your provider network is compliant. Yeah. So it.
Jon (08:54) Sounds like that would be 100?
Peter Bosworth (08:56) Okay. So, are those like real numbers I can work with like it’s 70 in Ohio and 30 in.
Jon (09:03) Yeah. And again, that’s why it’s changing because the 70 we had originally come up with was what our network would have had total, not counting the case managers and RNS in Ohio. When you add all of them in, you know, then the total number is going to go from like, you know, and we’re adding a little bit of cushion because, you know, like in Ohio, we have three nurse practitioners that are going to get added next month. We have, you know, potentially more people that are going to get added in the next month or two in Dallas, just, you know, for example. So, so yeah, that, I mean 100 right now… that would be, that would be the minimum. So medallion core, 100 comprehensive monitoring, 100 caqh management 100.
Jon (10:04) I guess I’d have to think about payer enrollments.
Peter Bosworth (10:08) Sorry, I can pull that back up because.
Jon (10:11) That number is going to grow too. If I have, right? I mean, like, if I’m counting now more providers at other clinics with other contracts… the… payer… enrollments would go up, no.
Peter Bosworth (10:29) Absolutely. Especially if you’re I mean, if you’re planning on credentialing them, right?
Jon (10:40) And when that says, I’m sorry, Peter, I’m you can tell me to slow down or we can come back to it. But no, this is great. Is 180 a unit is… a unit a payer or? Yeah.
Peter Bosworth (10:56) Good question. So it’s defined as per provider per payer per state. So getting your one RN enrolled with medicaid in Ohio?
Jon (11:05) Is one… so that… number is going to be dramatically higher?
Peter Bosworth (11:16) Based on the non, Ohio, or based on the fact that you’re credentialing more?
Jon (11:21) Just more people.
Peter Bosworth (11:22) More people. Is there any way you have like, do… you have a way to forecast what that number may?
Jon (11:33) Be… I mean, so if I have let’s just say let’s say on average?
Jon (11:46) Nashville, New York, Dallas?
Jon (11:54) Have let’s say six providers and we work with six payers to make it easy. So, so… six… so 36 times… 391, two, 114. So it would be 114 with just Nashville, Dallas and New… York. So then if it’s 114, just with them and I’m at 144 here, you know, I probably have… conservatively 10 contracts in Ohio with 70 providers.
Jon (12:58) So there would at least be.
Jon (13:04) Yeah, like I don’t that 144 number makes no sense to me because it just seems like ultra low even if you have, even if we were still at the 70 provider number, no.
Peter Bosworth (13:17) Yeah. I wasn’t a part of the sales process and the scoping there… but it certainly does seem low for the 70 number.
Peter Bosworth (13:28) I mean, because that would just be getting each provider credentialed twice like enrolled with two payers if you were to, you know.
Jon (13:36) Right, right. And again, you know, Ohio alone, I probably have there’s all these medicades and, you know, there’s probably six or seven different just medicades in Ohio.
Peter Bosworth (13:48) So that… we, what… do you mean by that? Like medicaid? Like because we would just hold the one with medicaid in Ohio, and then all the different, like plans under that. Is that what you’re talking about?
Jon (14:10) Oh, so medicaid would count as one even though there’s like caresource and buckeye and you.
Peter Bosworth (14:15) Know, oh, no, no. Okay. Sorry. No. So, it would, those would be separate enrollments. Yeah.
Jon (14:20) Right. That’s what I figured. Yeah.
Peter Bosworth (14:30) So, so 114… what was the 114 number? Again? You mentioned like national?
Jon (14:37) 114, the way I got to 114 was I took three of like the, not our smallest clinic and not our or I’ll say practice because practice can include multiple clinics, right? So, I’m not taking our smallest practice and I’m not taking our largest practice. I’m taking like the three moderately sized practices. So I’m taking Nashville, New York and Dallas. And I said, you know, there’s.
Jon (15:12) there’s six contracts. Let’s say they each have six contracts or they each work with six payers. And then there’s one.
Peter Bosworth (15:23) Two.
Jon (15:24) Three four, five. And just, you know, again, as a round number, someone might get hired or something. So I want to give it a little bit of cushion there’s six contracts at each practice. And there’s which I think is maybe a little low. But then there’s six providers at each practice.
Jon (15:47) So, if I have six providers each needing six contracts that’s… 36, right? Yeah, six is 36. And then I did 36 times three for Dallas, New York and Nashville. And that got me 114, 36 times, I need 36, three times, right?
Peter Bosworth (16:18) And how many providers per practice?
Jon (16:22) I was going to say six.
Peter Bosworth (16:25) Okay.
Peter Bosworth (16:32) Yeah. So… and then, sorry, just like backing up a second, the person who executed this agreement is Stan miller. Managing director. Is that person still at neurocare?
Jon (16:50) Oh, yeah. Okay. Yeah, that’s my boss. Okay.
Peter Bosworth (16:53) That’s your boss. Okay. Yeah. So I think what would be a next step here is like us, you… and I like spending more time to get a kind of precise order form together in terms of scoping so that I can share pricing and then… have you kind of like review that internally?
Jon (17:20) Yeah, yeah. Because what I’m I mean, I’ll just be, I’ll be totally transparent with you, Peter, my concern is that if it’s so vastly different, I’ll be, two things are going to happen. Number one, I’m going to be like might be priced out. And then number two, I don’t have like… I just don’t have the, if you guys can’t do all the management, like, if I can’t treat this like any other credentialing contracting group, I just, I don’t I physically don’t have the bandwidth with the people to, you know, go in every 120 days and do the reattestation and, you know, the regular monitoring and things like that. You know, it was going to be like a practice manager and maybe, you know, maybe another administrator if they needed help to complete everything on the front end. And then I thought like, hey, once we got everything on the front end, like we’re basically done then unless we get a new provider and then we get all the information in for them on the front end and then we’d be done, you know, but I don’t have bandwidth for people at the practices to do any type of ongoing management. I thought that’s I thought that’s why I got you guys, or we got you guys.
Peter Bosworth (18:55) Yeah, I think, well, I think that’s how that’s like our, how we’re think of ourselves right? Is that we’re asking for all the information up front. You enroll the providers in caqh management. We’re all you have to do is request enrollments, we will take everything else. So, yeah… and then regarding like being priced out. I think let’s get to let’s get to a number of enrollments first and then we can kind of see what we can do in terms of like unit costs. But rather than just not even attempt to, oh, yeah, yeah, yeah.
Jon (19:39) Yeah, no, no, for sure. Yeah.
Peter Bosworth (19:42) Okay. So if I was going about building this for there’s like four kind of SKUs that we’re talking about. It’s it’s… adding, so.
Peter Bosworth (20:01) You have 70 medallion provider seats and ongoing monitoring. So we talked about adding 30 more to make 100.
Jon (20:11) Is that correct? That’s correct? That would be the minimum right now?
Peter Bosworth (20:18) That would be the minimum. Okay? Because that just assumes almost no cushion at all. That’s just adding the ones that you already have into.
Jon (20:27) Medallion… well, if I have, if I have 70 just in Ohio, and the Ohio team’s the one that’s been working with Sandia and Connor, getting everything set up because that was like the long pole in the tent that’s the biggest group, 70 providers.
Jon (20:45) So, because… again, we didn’t think that RNS and case managers, were providers. So… so 70 with just them. And then if I have let’s say, you know, 18 with then adding Nashville, New York and Dallas, that brings me to 88. I have one provider in Pittsburgh, 89. And then that leaves me, you know, approximately 10 to bring on new people in the next, you know, new providers that will be coming out in the next… three to six months, you know, or at least three to four months.
Peter Bosworth (21:40) Okay.
Peter Bosworth (21:46) So, should we use that 30… additional or is it a bigger number?
Jon (21:53) Well, I mean, long term, it will grow, it needs to grow, but, you know, I think for now, you know, just like we had to come up with kind of like a number for right now.
Jon (22:12) I think 100 would be, you know, would be reasonable. I don’t think I’m going to bring on 10 more providers in six months.
Peter Bosworth (22:23) Okay. The.
Jon (22:25) The, the next six months after that, you know, that that’ll probably be a bigger number. But then we’ll already be established, you know, right? Okay.
Peter Bosworth (22:41) And then caqh management goes up to 90 And then payer enrollment.
Peter Bosworth (22:54) Yeah. So payer enrollment, the 114… additional seems maybe conservative.
Jon (23:06) Oh, no, it’s way too long. I was just, I was just saying like we just with those three smaller clinics much smaller than Ohio… you know, there would be there would be like 114 just there In enrollments, you know, but then if I have 70 providers in Ohio… and let’s just say just for round numbers for right now, we can get a more exact number, but let’s say there’s 70 providers, and there’s 10 payers, Yeah. So, is that seven? Is that 700 enrollments? Yeah, yeah… yeah.
Peter Bosworth (23:51) Are there seven? Are there 10 net new payers that the providers need to be enrolled with?
Jon (23:56) Oh, easy because we have, you know, again, we have all of those, give me just one quick second here. Yeah. Yeah… because, we have all those medicates that I was describing plus, we have all the commercials, we have medicare, you know? So we have blue cross, cigna, united, Aetna… whatever other couple of smaller ones. You… know, there’s many different medicates.
Jon (24:39) Yeah, I mean, there’s most definitely 10, I know that. And, and truthfully, I mean, once I get this first number, you know, I might even have to come back and go, you know, there’s a couple more, but at least if I have more realistic numbers, you know, like these, you know, and I know what I’m working with there, then adding a little bit more to that’s. Not as big of a deal this jump though. Is it’s going to be a significant jump?
Peter Bosworth (25:16) Yes. So, you’re contracted for 144 as we discussed, right? 700… I mean, we could, for the sake of, we could do 700 minus 144 or?
Jon (25:37) Well… like.
Peter Bosworth (25:39) In terms of additional, so, that would be like adding 556 additional.
Peter Bosworth (25:50) Yeah. Knowing that like buckeye and caresource, those are all individual enrollments.
Jon (25:55) Yeah, I would say then it would probably be 700 plus 150, not.
Peter Bosworth (26:01) Minus. Yeah. Okay. So… that’s helpful. The other… the last, the other thing is that we’re… basically like, right? Sizing the agreement in this exercise. And that part of that would also be you’re in a three year agreement. And so taking a look at years two and three in… which you’re also contracted for 144 each year.
Peter Bosworth (26:43) So, I guess the question is like, is that bump… in credentialing volume? Like going… to continue in year two and three?
Jon (26:59) Oh, wait a minute. You know what? I just realized, if the 70 people in Ohio are already enrolled there’s… not, it’s not 70 new enrollments, they already have all these contracts. It’s just a matter of getting you the existing information then, right? Is that just brand new enrollments or is that like once?
Peter Bosworth (27:24) Yeah, just brand new enrollments, like if they’re already enrolled… if, yeah, because, our job is to get them in network like even you have the contract, but we still need to credential them and submit the enrollment. Yeah.
Jon (27:41) So, so I think that number then is more than enough. The existing one. Okay. Yeah, it’s not going to grow to like an 850 because, the only new enrollments I have… would be the new providers coming on, you know, let’s say 30 40 enrollments maybe… a couple for, I still have a couple, just two enrollments for Pittsburgh outstanding. Yeah. So that number’s like more than enough?
Peter Bosworth (28:17) The 700 or the 144 the?
Jon (28:20) 144. Okay. So, sorry, yeah, because all these people, yeah, all these people have been, you know, working now, the one, that, the one, excuse me. So, the one thing that might skew it a little bit, is there’s major turnover with case managers? It’s nothing like, you know, your docs and your nurse practitioners, which, you know, there’s some turnover with them, but case managers, it’s typically higher.
Peter Bosworth (28:51) So.
Jon (28:52) When new case managers are hired, the enrollments for them. Yeah. But still, I mean, I… guess we could bump it to 250. I… think that’s, a more reasonable number 250 instead of 144, anticipating new nurse practitioners, new case managers, new therapists… brand new ones, in which case, they would have to have new contracts with, or they would need to be added to the roster for all of our payers.
Peter Bosworth (29:33) Okay. So that makes more sense. Yeah.
Jon (29:40) Yeah, because I’m thinking of it as like you guys are getting it for the first time and you have to do that work with them. So it’s all brand new, but it’s not, they’re already contracted. All these contracts are in place. Yeah, for like 99 percent. You know, we just have a little bit right now of like brand new stuff. Okay? And there’s not new contracts happening in Ohio, just new employees… right?
Peter Bosworth (30:15) So that, yeah… okay.
Peter Bosworth (30:22) So one six would be one… six is, oh.
Jon (30:29) I said 250?
Peter Bosworth (30:32) Provider rolls, yes. So 250… additional to the 144, no, just total. So 250 minus 144 is one six, one six added?
Jon (30:44) Yeah.
Peter Bosworth (30:45) One six added?
Jon (30:46) Additional. Yeah. Sorry. Okay.
Peter Bosworth (30:51) And would that be true in year two and three as well?
Jon (31:04) I mean, as well as I can predict the future, I think it would be.
Jon (31:15) . Yeah. I mean, I would think if anything, unless there’s a major problem, I mean, that number should only stay the same or grow a little bit.
Peter Bosworth (31:29) Right. I would think so. Okay. So, I know we just went over the hour mark. I’m thinking in terms of next steps, I will put all of this in a proposal and then share it with you… and then maybe we could reconnect on.
Peter Bosworth (32:05) Like Monday or Tuesday?
Jon (32:07) Monday would be great. Okay. I’m going to be in the, I apologize. I’m going to be in the car for some of the day, but, you… know, if I need to pull over and look at something or whatever I can do that, it’s no problem.
Peter Bosworth (32:20) Okay. When will you be not driving or would, you can do it? I’m just, I’m pretty open on Monday. So, when works best for you?
Jon (32:31) So, I got to go from, where are you based at Peter?
Peter Bosworth (32:34) I’m in Colorado.
Jon (32:36) Oh, okay. I have to drive from Pittsburgh to Detroit on Monday. So, I think I probably have like five hours.
Peter Bosworth (32:46) Oh, that’s a long drive nice.
Jon (32:48) Yeah, yeah.
Peter Bosworth (32:51) We can do it in the car. Yeah, that’s fine.
Jon (32:54) Okay. Yeah. Then really then really anytime is fine. You know, like midday maybe or like around this time is good?
Peter Bosworth (33:04) Yeah. So Eastern Time, maybe like.
Peter Bosworth (33:12) One one 30 Eastern Time? Perfect. Okay.
Peter Bosworth (33:22) Okey. Doke.
Peter Bosworth (33:47) Okay, perfect. I’m going to send you a calendar invite. I just sent it okay, and it will be a zoom but we can just, you can be camera off or whatever. Well.
Jon (33:58) That’s okay. I get on, I’m either on a plane or in a car. Seems like most of my life. So, okay, I can do the zoom in the car too, you know?
Peter Bosworth (34:10) Are you based in Pittsburgh? So.
Jon (34:13) I’m from Chicago and I moved to Pittsburgh five years ago, for work, and then that company private equity bought that company. And then I started working for neurocare four years ago, and, you know, I’ve just stayed in Pittsburgh because I travel all the time and, you know, Pittsburgh doesn’t have mountains like Colorado but it is, you know, it’s at least hilly and, you know, there’s some fun outdoor stuff to do. Cost of living is very low and, you know, and I like the steelers. So I just… that’s.
Peter Bosworth (34:52) awesome. Yeah, I’m from Baltimore and my cousins are in Pittsburgh.
Jon (34:55) Oh, no way. I,
Peter Bosworth (34:57) go to Pittsburgh. I actually just went to a wedding in oakmont which was kind of cool.
Jon (35:02) Oakmont. Yeah. Where the us open was? Yeah, yeah, very nice place. Yeah, yeah.
Peter Bosworth (35:09) Love Pittsburgh and very hilly a.
Jon (35:12) Lot of, oh, there’s like not a flat piece of ground anywhere. I haven’t found one yet. I mean, red bull and Audi do an event here because they have one of the steepest residential streets in the country. Yeah.
Peter Bosworth (35:31) And they.
Jon (35:32) Do that biking thing where like people are going up on bicycles and they’re all falling over and stuff.
Peter Bosworth (35:36) Yeah. I know I’m a big cyclist, so, I actually have seen that on YouTube. Yeah.
Jon (35:41) Yeah, it’s pretty fun. It’s like less than five minutes from my house. Yeah.
Peter Bosworth (35:47) That’s awesome. Yeah. Awesome. Well, John, thanks for your time. Look out for an email from me later today. Okay. Yeah, I may just send you kind of an initial email summarizing our conversation and the pricing may come later. I need to just connect with my manager on how we want to handle this if.
Jon (36:11) That’s okay. It’s a big number. It’s going to take a while to add up.
Peter Bosworth (36:15) Yeah.
Jon (36:17) That sounds fine. That sounds fine. Okay. All right.
Peter Bosworth (36:21) Excellent. Well, this, yeah, this shouldn’t like impede your process and implementation at all. By the way. We just, we will want to get it done, but everything should keep moving smoothly there.
Jon (36:32) Okay. All right. Very good.
Peter Bosworth (36:34) Excellent. Well, thank you, John. Nice to meet you. Good.
Jon (36:37) Meeting you. Take care. We’ll talk to you soon. Bye bye.