Transcript
Kira Fleshman (00:00) Kira.
Kira Fleshman (00:08) Hello?
Stephanie Ryan (00:09) Can you hear me? I can hear you how’s it going? Okay?
Kira Fleshman (00:13) It’s going well. How’s your week been? It’s.
Stephanie Ryan (00:16) been good. We’re going on vacation next week. So just trying to cram a lot in before I’m out for the week.
Kira Fleshman (00:23) Yeah. Oh, that’s fun Friday before vacation. Where are you guys going?
Stephanie Ryan (00:28) We are going to San Diego. My boys have never been, so we’re excited. Yeah.
Kira Fleshman (00:35) That’ll be fun. How old are your boys?
Stephanie Ryan (00:37) Two and almost five? Oh.
Kira Fleshman (00:39) My goodness. Okay. City vacation with toddler… and is your five year old in kindergarten?
Stephanie Ryan (00:47) He’s starting in the fall. Okay. So, this is his last year of pre K, but my youngest is wild. He is the second child through and through. So I’m a little nervous for the plane ride, but we’ll see.
Kira Fleshman (01:02) That’s so fun. San Diego is one of my favorite cities. It might be my favorite city in the states that’s just so.
Stephanie Ryan (01:11) Yeah, we, I have been on a girl’s trip there and then my husband and I went for a wedding before we had kids and we both, we love it. And there’s surprisingly like a lot of family friendly stuff to do in San Diego. I actually just was, I used chatgpt and I was like create an itinerary for me. These are the days we’re here. This is how old my kids are and it like put together a whole list of ideas for us. So we’re excited. We’re also doing the hotel route, which we’ve never done with them. We usually do an airbnb, but it’s hard to find swimming pools in San Diego that aren’t at hotels.
Kira Fleshman (01:50) So, oh, yeah, you need a swimming pool. If you’re taking young boys. Yeah, yes, I feel like swimming pools are always you just like the energy, the amount of energy they can get out swimming in the pool, like at night before they wind down for bed. I feel like that’s always when we take the kids to the pool.
Stephanie Ryan (02:10) Yep. Exactly. And I was like we are coming from Minnesota even if it’s only 70 degrees like that’s gonna be like a heat wave for my kids. So, yes, we needed a pool and we’re staying like on the bay. So it’s not like the ocean, but there is like a beach where they can like build sandcastles and different stuff too, which will be fun.
Kira Fleshman (02:31) That’s good, great.
Stephanie Ryan (02:33) Yeah. Well, thanks for taking some time to connect here. I thought our call on Monday with the larger group was like a really great chance to level set and kind of align on where the pain points are. I do think. And I’ve said this before. I think you have the right people on your account today. I hope you’re noticing that there’s an increase in response times and we, we’re taking what you need very seriously and here to support wherever you can or wherever we can. But I wanted to take some time today. I know we’re going to talk after this with the larger group just on like that escalation, doc. Yeah. So I don’t think that we need to focus there right now, but I do just want to hear from you more about your priorities for this year. I know that SLA reporting is one of the bigger ones that we’ve discussed and it’s high priority for us. I think we’re trending well there. But in order to say like we feel, really confident in what we’re producing, we’re going to give that another month. But I also want to hear like outside of, you know, your support and your making sure that we’re meeting our committed to metrics like what is the focus for Iris? And where can we partner better? Or we can maybe partner more together?
Kira Fleshman (03:55) Yeah. So there’s a lot really because, you know, at Iris, things are moving probably not quite as fast as your org is a little newer but, and it’s kind of in that high growth mode. But we as well obviously are trying to grow. So… our solutions team which we didn’t even have up until probably six months ago or so has been working on a set of, solutions, new products that we want to take to market. And I won’t tell you all of the things that we’re working on just because there’s not enough time. But one of the things that we’ve really been tracking towards is having our own emr. I don’t know if you even knew we didn’t have our own emr. Well, yeah, you probably knew that because, you know, we work in our partner’s emrs but there is a level of… a lack of control and visibility when we don’t have direct access to the emr. And so that is something that we are building right now, the capability of our providers, especially the ods providers. I think you’ve heard us talk about the three different service lines if you will that, we have scheduled services. We have ods and we have virtual clinic, ods and virtual clinic are our per encounter models. Scheduled services is our fixed pricing model. And so our own emr capabilities would probably impact our per encounter businesses, ods and virtual clinic. And then, and also building the capability of RCM revenue cycle management. And so, one of the things I did want to put on your radar and I’ll likely get a call scheduled for us is to see if I think you all have a payer enrollment product. Is that right? Yeah.
Stephanie Ryan (06:00) Absolutely. Yeah.
Kira Fleshman (06:02) I mean, the biggest thing for us is we have obviously we have a super tight budget and, you know, and we have, I think last call we had where we talked about our consumption or lack thereof. Yeah, I did a quick math in my brain and it was like by the end of our contract, we’re going to have like 200 K of unutilized consumption, probably even more than that. And again, I just did rough math. And so I’d love to look at those numbers so we can actually trend out what we think we’re going to use. And really what I’d like to see is if there’s opportunity to you, what can we use, that extra consumption for? Yeah, whether it’s the pay or enrollment stuff. And the other thing is, you know, when you think about like we’re scaling this business. So I don’t know that… someone else is managing the discovery work there and then the implementation. So actually I shouldn’t speak for him, but in my mind, like I have no idea about the potential volumes that we’re looking at. So I want to have that conversation and just give you a heads up that I would love to start talking about how we can use these dollars that we’re not going to spend.
Stephanie Ryan (07:32) Yeah, no, I hear you. And that’s part of my like my job with you is making sure that you’re maximizing your contract. So this is the right forum for all that. I did pull an updated consumption deck for you that we can just look at and I just pulled it like a half an hour before this call.
Stephanie Ryan (07:52) So it should be like very up to date. And so there’s a lot on this screen. I just kind of repurposed what Janine was using because I thought this might be the format you’re used to, but we can change this. I know there’s a lot like essentially your year two contract value was for 416,000. You carried over 104,000 dollars from last contract year. And based on your consumption today, you’ve got 447 K remaining and some change. So you’ve only consumed for the year for this contract year? Yes?
Kira Fleshman (08:35) Okay. And then we have a third year that we’re committed to or no, how long is our?
Stephanie Ryan (08:40) Overall contract, your term is up at the end of December? Oh.
Kira Fleshman (08:44) It is up at the end of December. Okay?
Stephanie Ryan (08:47) But what I wanted to show you is I have the ability now to pull your upcoming consumption. So these are requests that have been put into the system, but haven’t actually hit your consumption. I’m happy to see that you’ve got 125,000 dollars worth of a consumption that’s coming up based on the request that your team have put into the system. But even so with that, I would say I just was looking at the math here. You will have consumed or you will have about 320,000 remaining in your contract to… spend. Now that being said we are in April, your contract goes until the end of December. I would imagine there’s going to be more requests that are coming but you are making more of a dent than what I had initially thought when I didn’t have the access to pull your upcoming consumption.
Kira Fleshman (09:52) Okay. So why did I think that our contract? Our contract length was 36 months to where we were committed through December next year. So.
Stephanie Ryan (10:05) Year two ends at the end of December. You’re at full contract term. And again, usually I have this on the slide. So I’m going to add that in so that we don’t have to question it. Again. Your contract… no, the term end date. No, yes. 1,217 27 is when the full contract ends. So you have another year after December. And again, anything that isn’t used in this contract year will carry over. So you don’t have to worry about like at this point using it and losing it once your contract ends in 20 27, that’s where any dollars that are left on the table, they don’t carry over. So we’ve got time to use it. Our payer enrollment model typically how we use I’m gonna back up. So within your contract, you have language called SKU flexibility. And what that flexibility allows is for anything that you are contracted for, you can use in other buckets. So, you know, you have contracted for 959 core seats, you’re using 621.
Stephanie Ryan (11:24) If you were to go over your hospital application number, we could pull it from other SKUs that you’re contracted for. Where we typically don’t allow for that SKU flex is for other products that you haven’t purchased. So that would mean payer enrollment. That being said, there is a case to be made here that like you may be able to, we may be able to borrow SKU flex for payer enrollment and I will make that for you internally.
Kira Fleshman (11:56) Okay. I mean that’s what I would appreciate you kind of socializing that with your team a case to use it towards payer enrollment or I don’t know what other products you have just, you know, given the history of our relationship together and all the ups and downs and the resets and whatnot, not to mention, you know, we haven’t I know last time you and I talked, we talked about the lost revenue. I was going to get you some details which I haven’t yet but like Janine has them in her email, if James has access to her old emails and I believe we had copied Amy on that as well. So Amy should have it. The right people should have it. Yeah. And I know we had talked about a potential refund, something… would go a long way and, I would love to be able to consider using your payr enrollment product to.
Stephanie Ryan (13:04) Yeah, absolutely. So we have a payr enrollment product. We obviously are doing licensing with us. We’ve got like delegated roster generation. I don’t know if you guys are doing any delegated work where you need rosters?
Kira Fleshman (13:18) I don’t know. I’m not even really. I don’t know enough about that to be able to answer that for you, but, I need to get as a next step. I mean, I was going to ask you what you think the next step should be. We have someone here at Iris who is leading that, the work on building the capability of RCM and I think he would be the right person for you all to talk to. But I wanted to just say, yeah, I wanted to talk with you first. So you had some context versus me just scheduling a call with him and whoever on your team to talk about what the options are. Yeah.
Stephanie Ryan (14:02) So, I think there’s a couple next steps here. I think first, I’ll just send you our one pager overview of our payr enrollment solution that you can definitely surface internally. And then I do think that the right next step is setting up a call with whoever’s setting up your RCM team to… talk through what our capabilities are, what we offer, how the technology works. And then we can figure out like pricing and things as that conversation is going on. I’ll have some conversations internally in the background, but either way, I think it would be good for you guys to learn just a little bit more about what we’re doing from a payr enrollment perspective. So if you wouldn’t mind putting me in touch with that person, I’ll give you a one pager in the meantime that can be shared internally. And then either you can be a part of that conversation. I know you’re limited on time. So if it’s like this really doesn’t pertain to me like let me know what the outcome is. I’m happy to do that. I’ll probably.
Kira Fleshman (15:03) Put myself on as optional and you’ll know Jill, you already should know that name. She’s on our weekly call. She leads our ods operations team because RCM is going to go live in her space first. She’ll probably be part of these conversations as well. So I envision it’ll be Christopher, Jill on our side with me as optional. And the one pager would be helpful. I’ll forward that to them ahead of scheduling a call?
Stephanie Ryan (15:36) Perfect. That sounds great. The other thing I just want you to know is if… we go live with payer enrollment, I’m assuming there’s like is there going to be a subset of new providers that then are going to need to be added to the platform?
Kira Fleshman (15:52) No, I don’t well, I don’t think so.
Stephanie Ryan (15:56) No. Okay. Because if they, I was going to say if there’s any new providers that’s going to take up a core seat too, which you’ve got plenty of room in your core seats for that to be accommodated. But that’s another way that we can use up some of that consumption and you’re already purchased like you already purchased that SKU. So, if we were adding like more providers and it was maybe going to get you to that threshold, it would be an opportunity for me to look and say, well, if you need to add more providers, maybe we can price you at a better rate. So, those are just things to keep in mind for how we can leverage more of your contract is, if you’re adding more providers, and then we will talk about what we can do from a payer enrollment perspective. Okay. Go ahead.
Kira Fleshman (16:47) No, go ahead.
Stephanie Ryan (16:48) I was just, you know, I hate to play the new card but I am newer to your account. I obviously wasn’t here. I did not sell you on this, when it came to the numbers that we were forecasting, and Kira, I know you weren’t a part of this either, but has there been conversations internally about how you landed on the quantities that you needed for this first contract round?
Kira Fleshman (17:10) Yeah. It was our finance team forecasting our business three years out essentially. Okay.
Stephanie Ryan (17:18) Okay. Yeah. So they maybe didn’t take a conservative approach with that. They, and, I don’t oh,
Kira Fleshman (17:24) I believe they did take a conservative approach and it was still way off. But I mean, you know, it’s hard to, it is really hard to forecast out our business three years, especially because our sales engine hasn’t been a stable engine. So yeah, I mean, you know, at some point, I do want to go back to them and just share where we’re at so they can fine tune, and kind of, you know, yeah, fine tune their assumptions and how they would forecast something like this in the future.
Stephanie Ryan (18:05) Okay, perfect.
Stephanie Ryan (18:06) And then I want like cause I’m just looking at your year two numbers right now. Like with your upcoming consumption and your 72 like your 73,000 to date that’s been consumed and another 125,000. You’re at essentially 200 K that you will have consumed and you’re not even halfway through this contract year. So I feel like you’re like had you not carried over year one, I would feel pretty confident about how we’re trending to date. That being said we did. I mean, you carried over like 100,000 dollars from last contract. So.
Kira Fleshman (18:47) So, are you able to forecast like where do you think we’ll be at the end of this year… under the assumption that whatever rolled over from last year rolled over, that’s fine. That should be part of the equation and what, you know, we will be consuming like how much do you think we’ll carry over from this year to next year? And then can we even map that out further? Like?
Stephanie Ryan (19:12) To, and,
Kira Fleshman (19:13) I did the math when I was on the phone with you all, but I figured you’re in these numbers all the time. It’d be great if you could kind of forecast it out based on our prior consumption. Just base it on the last, what we know, year to date or contract to date.
Stephanie Ryan (19:29) Yeah. I mean, I would say if things stay pretty steady, I’m looking at your recred dates right now, give me a moment. It’s loading.
Stephanie Ryan (19:44) Those are probably already in, let me see what would have already started. Sorry, this is being a little slow that’s okay. I just based on what I’m seeing and how like my initial, I think, you may carry over like 50 K is what I’m thinking to next quarter or to next contract year. Is where I think I’m landing, I can do a better analysis and.
Kira Fleshman (20:17) Then assuming next year is similar to this year in terms of consumption… what will be our unused balance then at the end?
Stephanie Ryan (20:27) So, let’s say that everything’s pacing as it is today. And again, this is like as if, you know, either you’re just backfilling you’re, not doing any like growth hiring and things are staying pretty status quo. I personally think that of your total contract spend, you will be, give me a moment here. So your entire contract is 814 K. I think you may be… I think you’ll consume at least 750,000 of that… OK?
Kira Fleshman (21:07) So, my, I overestimated a little bit at 200, I was kind of estimating 200 K would be.
Stephanie Ryan (21:15) Well, and that was without the context of what I just gave you of this 125 K, right? Like that’s, a large amount of consumption that you’ve requested. It just hasn’t been in a workable place yet to hit consumption.
Kira Fleshman (21:29) So, when.
Stephanie Ryan (21:30) we, when I initially showed you this in the last Mor, I was like we’ve only consumed, you know, 75,000. This is like I’d love to talk more about what’s coming. And then when I was able to look at your upcoming consumption, I’m like, OK, this is looking a lot more to where I thought we would be.
Kira Fleshman (21:47) OK. So is there any way in next time we look at this to look at it? I don’t even really care about the product names because it sounds to me like you said we.
Stephanie Ryan (22:02) Can have a bucket of money. We.
Kira Fleshman (22:03) have a bucket. So let’s just do one bucket. And I’m just high level curious, you know, for one year, two year, three year, how much, how big was the bucket? How much did we consume? Then just trending that onward through the rest of our contract. Where do we think we are? Where do we think we’ll be at the end? Yeah, I think that would be helpful. And, and so you would, obviously, you would add in this consumption 125 K and you could line item and out the way you think would make the most sense, but I don’t need it by the individual.
Stephanie Ryan (22:46) No, I hear you. We can take it up a level and then I can give you this as like an appendix for if you’re wondering, yeah, where are we consuming most? Where are we under consuming things?
Kira Fleshman (22:55) Yes, I think that would be super helpful because then that’ll give me a better idea of how much money we potentially have, and I realize this will require some work on your part to… have conversations with your team. It would give me a better idea of the bucket of money we have that we could potentially apply to pay our enrollment because we’ll be looking at various vendors. There is my assumption and I don’t I would rather use the money we’ve already, you know, committed to in this contract on that versus spending net new dollars. Yeah, no.
Stephanie Ryan (23:37) I hear you yep. I can do some work there. I’ll talk to the team internally and see if we can do any forecasting and then I will bring it up a level so that you can see like year one here’s, what you purchased here’s. What you consumed, year two, here’s, what was carried over here’s. Your total dollar amount here’s. What you consumed with upcoming consumption and actual. And then year three, like this is what it looks like. Yeah, yeah. Okay. Cool.
Kira Fleshman (24:03) I think that would be great. And then, the other thing you asked me just in general, like what are our priorities? And one immediate thing that I haven’t had a chance to talk with you about is Erica’s departure. We are in the process of backfilling. But my question to you is how can we utilize… your all’s teams to help with? You know, there’s a gap for sure. There’s going to be a gap until this new provider this new person starts. And it’s putting a lot of pressure on our teams because, you know, it’s Annie and one remaining specialist. And yeah, we have all these other priorities that are pulling us into various directions. So limited bandwidth. Is there something… can you think of any way that medallion can lean in with under our current contract terms? I’m not asking for anything, you know, outside of what we agreed to. Is there anything that your team can do to lean in let?
Stephanie Ryan (25:14) Me check with the team. I’ll just surface that Erica’s leaving and see if they have any ideas of like based on what she was doing in the platform? Like today, how can, like, can we take on any of the work that they were doing? I don’t I apologize. I don’t know specifically what, how Erica was like interfacing in the platform. I don’t know if it was more from like a request standpoint, or?
Kira Fleshman (25:39) You can ask, I think Jen is probably the one who’s going to have the most visibility and insight from my understanding. And this is from these are Erica’s words. She said, she spent a lot of her time and I didn’t like test this out or like, I don’t know how much this is true or how much this has legitimacy. She was spending a lot of her time. She said checking and double checking that the medallion tasks.
Stephanie Ryan (26:11) Were.
Kira Fleshman (26:12) being completed and like kind of managing the process to make sure that everything was getting done for our ods providers, whether it was medallion who owned a task and getting that done, in a timely manner or if it’s our provider owning a task which we own that communication. So that’s something we would have done anyway. But like, I guess if I ask for something specific, if you could ask Jen, what… is her confidence level that the medallion team is doing? What? You know, they need to be doing within the timeframe that they need to be doing it specific to our ods provider population? Yeah. And.
Stephanie Ryan (26:52) without having to be.
Kira Fleshman (26:54) Bugged, yes. Yeah. And that was, that would be like if I could take that off of Annie to where, and some of this might’ve been rooted in just the history of, yeah.
Stephanie Ryan (27:08) I’m wondering if there was like a lack of confidence, oh, for sure. Like I need to like, I, I’m overseeing this for.
Kira Fleshman (27:16) sure, more.
Stephanie Ryan (27:17) Than I maybe would in other scenarios, cause I want to make sure that it, right? I totally hear that.
Kira Fleshman (27:24) So, I’d love to be able to drop that, right? Cause we shouldn’t have to be checking and I’m not saying she should have been checking, but she definitely, there was something that made her feel compelled to have to check and that was taking up a lot of her time. So it was that kind of stuff. But then there’s also, I think she was doing the Iris, you know, medallion will assign some stuff to Iris admin, right? Like is I don’t know what these things are, these tasks? Yeah. Are these absolutely things that Iris would need to do? Or is that something potentially that medallion can help with until we have a new person up and running?
Stephanie Ryan (28:00) My guess is if we’re tasking it to your admins, we… there’s a valid reason that we’re tasking it out to them. Where I, my initial thought process goes is and I don’t know what, how you feel about this, but are we tasking your admins? And we should be tasking your providers because if that’s the case like… that would take the onus off your team but they may need to follow up with the provider to say, hey, we need this if the provider’s not going into the platform and answering what we need in a timely manner. So.
Kira Fleshman (28:37) We do have that level. Our practice managers usually do that versus the Erica and the Emily, they’re the MSS specialists… but let’s we can talk about it more in Monday’s meeting. I know we want to go through this escalation protocol next. So, yeah.
Stephanie Ryan (28:56) I’ll hold it by my team and I will, I’m out next week, but I’ll see if I can get a response by the end of the day here. And if not, like, we can keep thinking about it and I’ll circle back with you.
Kira Fleshman (29:06) Okay. Sounds good. All right. We.
Stephanie Ryan (29:08) Will talk in a minute, yep.
Kira Fleshman (29:09) Bye.