Transcript
Zo Hooda (00:00) hey, Mike. Good afternoon. Good.
LHD Michael Fett (00:03) Afternoon. How are you? Good afternoon. Can you hear me okay?
Zo Hooda (00:06) Yes, sir. Loud and clear. I’m doing.
LHD Michael Fett (00:09) Well, all right. How are you?
Zo Hooda (00:11) Oh, it’s good. It’s been a good start to the Monday. I was able to get my physical activity in the morning and then it’s just been back to back since. So, gotta love a Monday like that.
LHD Michael Fett (00:22) Yeah. Where are you located?
Zo Hooda (00:25) I’m in Austin, Texas.
LHD Michael Fett (00:26) Oh, okay. Okay.
Zo Hooda (00:28) Yeah. What about yourself? I saw Phoenix, she’s.
LHD Michael Fett (00:31) got a personal trainer. She’s a bodybuilder and they’re in Austin, Texas. So.
Zo Hooda (00:36) Oh, no way. Nice. Yeah, it’s a good community. It’s.
LHD Michael Fett (00:39) been a while since I’ve been to Austin.
Zo Hooda (00:42) Oh, yeah. When was the last time?
LHD Michael Fett (00:44) Probably about the end of the year.
Zo Hooda (00:47) Oh, okay. That’s when that weird culture of Austin was thriving.
LHD Michael Fett (00:54) Yeah, it’s been a long time. I used to be in public accounting. I used to go and audit there, and I would go to the doubletree hotels and that’s when I got hooked on to a restaurant called papados. And papacitas.
Zo Hooda (01:08) Which.
LHD Michael Fett (01:09) most people don’t know about here until they actually opened a papados here in Phoenix. So, no.
Zo Hooda (01:16) They did. Did, they?
LHD Michael Fett (01:17) Did. Yes, yes, they did that’s. Awesome. Yeah, I’ve been there a couple times. It’s very good. It’s just on the other side of town from my house. I mean, in Phoenix, if you’ve ever been to Phoenix, it’s huge. It’s urban sprawl. So, I mean, you can drive an hour and a half from one end to the other. And you’re still within what’s considered Phoenix basically wow metropolitan area. So, it’s just huge. And depending upon the traffic and everything, it’s like it’s just sometimes not worth going all the way over to the other side of town.
Zo Hooda (01:49) Yeah, you have to have a real craving for it to justify that drive absolutely.
LHD Michael Fett (01:55) Well, hey, I want to thank you for the cookies and thank you for reaching out and so, just wanted to get a little time here to touch base and you can kind of tell me what you guys do, and we can see if there’s a potential to talk further or not. So. Yeah, I.
Zo Hooda (02:15) think that sounds like a plan. I think the goal for today is to figure out, is this our first goal or is this our last goal, right? So, no, it’s very nice to meet you, Mike. And just as for an introduction, my name is Zoe. So I’m the account executive assigned to southwest behavioral health and services from medallion. So if you were to evaluate medallion, I’ll be your main point of contact for that evaluation, bringing in the relevant resources necessary. I have a lot of experience working with, you know, companies from digital health to specialty provider groups, to large health systems. So, you know, I saw southwest behavioral services. We work with a lot of behavioral health companies. And so that was the reason why I was interested along with my research and of course, with the cookies wanted to congratulate you, for 23 years, it’s pretty awesome. Well, thank you.
LHD Michael Fett (03:02) Yeah, thank you.
Zo Hooda (03:03) Yeah. So I think the goal today is like I’ll definitely give you a bit of an overview of medallion now. But then I would like to understand how sbh operates currently from a credentialing pan enrollment function from there. And then we can kind of understand like where if they are areas where medallion could provide value and then we can mutually decide if there’s next steps to be had towards the end of this call. Okay. Yeah. So just to kind of introduce, medallion, we are an automation platform for provider operations. So we automate the entire provider operations and tenants. What do I mean by that from provider onboarding to primary source verification and getting them credentialed to getting them enrolled with payers, to licensing, to ongoing monitoring and compliance, to privileging… whatever can be automated in any of those processes. We’ve automated. And then we also have an operations team as well that provides the human in the loop where there needs to be a human in the loop. And typically when we work with organizations, it’s typically when we work with them, we hear a lot about a few different things. Well, my current process is very manual. I have a whole team dedicated to this. We manage it in excel or some self serve software. And it’s very manual. And because of that, there’s room for human error. And what that leads to is a few different things especially when I talk to cfos number one, we’re having a lot of provider growth, which means I have to hire a lot of credentialing specialists to keep up with that provider volume. So therefore my opex is increasing, it’s linear with my provider group with my provider growth. The second thing is well, it’s a very manual process. So when we’re from a provider, when they sign their offer letter and their start date to when they’re fully enrolled and can start seeing patients and can start billing. It takes a very long time, you know, 90 to 100 days we see as the industry standard. And then lastly, you know, it’s a very manual process for credentialing and payer enrollment. And so we’re seeing claims and else due to credentialing errors or we missed a revalidation. So we’re seeing some claims and else. And so what medallion differentiates from self serve software. And of course, you know, manual processes is through automation. And so our entire engineering team, we have integrations with every single payer in every single state. And so what we’ve done is we built the workflow for getting providers enrolled with payers to their state to specific. Payers needs and requirements. We built all of those workflows within our platform so that there’s no room for error when it comes to some of those manual and repetitive tasks. And so essentially, what we see is that because of medallion’s automation, there’s three outcomes that we drive, which is number one reducing op. Ex. So with our current customers, we find that they only need to have one credentialing staff member to support up to a 1,000 providers. And that’s because the technology of medallion allows them to absorb a lot more volume without, you know, executives having to hire more staff. The second thing is because of the automation because of our integrations with the payers, because of how quickly we get applications submitted and how quickly we can produce a credentialing file which we have slas to back that we get providers enrolled 40 to 60 days, which is a big difference between 90 to 120. And then lastly on the claims piece, as I mentioned, there’s no room for human error when you’ve automated everything. And so we have a 99 point five percent credentialing file accuracy, which means when it comes to claims denials due to credentialing errors or revalidation errors, or maybe the provider started billing without being fully enrolled with a specific payer, we’re minimizing those because of the accuracy we have, and also how we task these maybe pending items to both providers and your administrative staff. So that’s kind of at a high level what differentiates us, but also what the automation drives in terms of some measurable outcomes especially when we work with cfos. So I’ll pause there and see kind of your reaction to that thoughts overall before we kind of, I do have some questions but yeah, we’d love to get your thoughts on that.
LHD Michael Fett (07:28) Sure. So, you know, we’ve had our credentialing has been a bit of what I call a hot potato. It’s been, it’s been passed around to department. And typically things end up, in finance once they are problematic and people don’t want to deal with them because a lot of these processes end up costing the company money at the end of the day. And so I oversee the claim shop. So I used to, in my role, I was still, I’m a chief administrative officer. I still have it over me under me, I mean, but we actually had so HR, human resources used to be under me too. And that’s now split off to be a separate under a separate C suite individual. But we used to have the credentialing in HR and it was like, okay, this made sense because they’re onboarding our providers and, you know, in terms of who we credential and everything, I mean, we have probably somewhere in the neighborhood of.
LHD Michael Fett (08:42) We usually don’t hire pas because they require supervision. But then we do have some msws lpcs that we credential as well. So the number could be closer to 75 or whatever. And then of course, we have to credential all of our sites and everything as well. But we have, you know, probably at any one point, we probably got close to 25 different sites that we’re credentialing as well. So maybe 100 and so that process wasn’t working well. It got moved out under me. But under our, what we call our client financial services, which is our billing flex enrollment eligibility department. So we had one position that was doing all this and that position transferred over. So, we worked to transition and put kind of a workflow, a process flow, a desk procedure kind of a, we put some structure around the process. We put some timelines around it. And so we actually have had that in there for a while. Ironically, we just actually moved it back to human resources, which is now not under me because we have a compliance person who also used to do credentialing for a lot of inpatient hospitals and things, who has a lot of expertise. And it seemed like, you know, we’re really improving our processes within HR. So I think it made sense to move it back there because there’s a lot of information flow and it’s very difficult to get things from providers. They don’t want to provide the information, they feel that they’re being asked personal information, that some of them refuse to provide it. And it’s like, okay, well, then we’ll rescind your offer of employment. If you’re not going to do this. I mean, we’ve had to get that blunt about it, but you are right. We are doing it on a spreadsheet and we’re tracking it manually and everything else. Now, whether or not it makes sense to move to a product like yours. Honestly? I’m not sure. I’m sure that this process that since it transitioned probably about six, eight weeks ago. My guess is it’s probably going through some other, you know, reformulation because any time the process moves to another department, everybody’s like we need to change this. We need to fix that. So, you know, and where this and the reason it kind of came about was it was like, you know, we just have, you know, one person in our billing department and they don’t carry a lot of weight against a lot of the docs and they don’t know a lot of what’s going on with the status of their employment, what’s their start date? When are they? You know, things change? And then they don’t get updated from HR. So it made sense to have the power of HR being the one managing it so that they would, so that HR could actually say, wait a minute. You have not provided us this information.
LHD Michael Fett (11:48) We gave you a 90 day start date. We are now going to push that back another 30 or 60 days for you to start with us because you have not provided us with this information because what happened is we had not had that communication. So then they start after 90 days. But then they had been refusing to give us all the information to get a credential and there was no communication back to HR saying, wait a minute. Dr xyz did not provide his information. So he’s not credentialed and that means in our world, here in Arizona, we can’t have them provide they can’t do scripts. So they technically can’t do they really can’t do anything. So we’re paying a high level position for things that now it’s like, well, what are they going to do? So then it’s determined. Well, do we just let them go? You know, because it could take another 60 to 90 days.
LHD Michael Fett (12:41) And the way the plans work and the way our medicaid system works like especially the plans, you know, even if a provider moves from one provider to another, it’s like they still have to be re credentialed again, which I think is absolutely ridiculous because, you know, it’s not like a hospital system or a hospital grants privileges, right? This is where the health plan now has to go through. And this doctor could have been working for one of our competitors for five years with no complaints. No, nothing. Then they come work for us. It’s like, well, then they got to go through this whole re credentialing process. It’s like, but nothing changed regarding their licensure status, their Dea status, their certification, their specialty, nothing changed. It’s just, they’re working for a different company doing the same thing. So we’ve created a big problem with that. And so that’s what compounds all this. And so, but what I’m thinking, you know, definitely would be, I think very beneficial to talk to you more about this. What I think since I’m no longer in the loop on this, it’s kind of out of my wheelhouse now, if you want to send over an email, I know you sent me an email to schedule this, but I would be happy to introduce you to Dan, who is my counterpart, he’s the chief people officer. Okay? And I would be happy to introduce you to him. And that way, you know, I can talk to him and say, hey, you know, I’m going to be forwarding you an email, you know, from Zoe and I think it might be beneficial to talk to you. I mean, I know that this is a huge process and the thing is it’s constantly changing. I like the idea that you said you’re connected with like all these payers and so, I mean, you know, managing all of this, I would like to see because it is a problem point for us. It is a pain point for us. So, and nobody wants it. They really don’t but everybody’s wanting to do their best, but it is a hard process. So I’ll stop there and that’s kind of just very upfront with you. I mean, I think that it’s something that I would recommend that they maybe listen to you and talk to you and maybe get a demo. You know, one of the things is, are we going to get one involved in another service, another price, another cost and what’s the value for it? And, you know, we’ve always talked about, you know, do you need one person or do you need two? Because if one person quits, then you’re in trouble because all of a sudden, well, then nobody knows. So we,
Zo Hooda (15:39) I think I’m losing you.
LHD Michael Fett (15:56) In our area, my area, we have to do some of the basics to some degree. So, okay, I’m free. Can you hear me now? I?
Zo Hooda (16:04) Just got back to you. The last thing I heard was, can you hear me now? I just turned.
LHD Michael Fett (16:09) off my video. So, yeah. So I was just saying that, I think that, you know, we had somebody who was, we took somebody and we kind of, you know, had them do a little bit of cross training on the critical stuff, right? Because if you have somebody leave and they’re the only credentialing person, well, nobody knows what to do. Even the supervisor isn’t in on the day to day things because there’s so many things in play, right? So, and I don’t know how they’ve taken it over down in HR, but like I said, I’d be happy to provide an introduction sure and take it from there, so.
Zo Hooda (16:43) Yeah, no, I appreciate the background and kind of the candidness. I mean, there’s a few things that you mentioned that I think we can address pretty easily like you talk about getting providers onboarded with. Medallion. We make it, very easy for them to provide the information. In fact, we are one of the only platforms that has an integration with caqh. So when a provider’s tasked to fill out their profile, we pull 80 percent of the required information from caqh automatically. And then we have things like, you know, you can upload your resume and we’ll have our AI scan it and then fill in the information. So with that we actually get providers onboarded like their profile complete within two point like on a median of two point three days. And so, you know, I think in my conversation with you obviously, Dan, he’s the one that’s now owning this function. But of course, you’re not going to, you know, as an organization as executives, you’re not going to buy anything that doesn’t make sense financially to buy, right? And so, I think when we first think about the one thing that you said that stuck out to me which was these processes end up costing the company money. And so I was curious like in what ways do maybe delays in getting providers credentialed or delays in getting them enrolled? How does that surface in terms of costing the company money?
LHD Michael Fett (18:03) Well, I mean, in theory, it takes a lot to onboard a provider… in terms of the recruiting effort. And in some cases, we may have already had them come on board and we’re paying them a high salary. And then if they can’t if they can’t it’s already hard enough for them to be able to earn their salary based on the medicaid rates that we have. So it’s like they can’t if they can’t bill for seeing patients… you know, maybe, they could possibly do an assessment or something like that, but they can’t do, they can’t do any prescribing because, it’ll all be blocked. So they can’t do any net evaluations. So they’re really hand tied in terms of what they can do and pick up schedules. And, and so I’ve always said, you know, if you look at any nonprofits, it’s 990, you know, yeah, sure. You’re going to have the CEO on there in terms of compensation, but all the other people are all, you know, from a psychiatry perspective, from a behavioral health perspective, it’s all the psychiatrists. I mean, because these are people who are making well over 400,000 dollars a year. And then if you can’t have them, if they’re only seeing a handful of people, it’s like you’re losing money by the day, right? I mean, you’re losing, not only are you paying somebody who’s not even be able to serve all your patients. But then at the same time, you’re not able to bill extra things from the health plan on top of it. So you’re losing money and you’re paying you’re losing revenue and you’re paying extra expenses. So that’s why we’ve had to say, I mean, if this gets to this point, you know, you’re going to have to start six days later and then they might quit. And then you start over looking for a new prescriber again and, you know, we quit doing this. But it’s another thing where when I say cost money. Sometimes if it’s really needed in a program, you may need to bring in a locum tenens, and if you do a locum, tenens, you’re going to pay through the, you know, notes for that.
Zo Hooda (20:19) Yeah, yeah, no, that totally makes sense. And that is what we hear a lot like we hear, you know, we’re paying the salary for a provider, but our credentialing and enrollment process takes so long that we’re just paying their salary while, you know, while we’re waiting for them to get enrolled.
Zo Hooda (20:38) And so the way I think about that is revenue acceleration, right? So, I’m curious from what you were saying in the business, when a provider, you know, signs on and signs are off later from that date to when they’re fully billable, they can start seeing patients and fully billed for their practices. How long on average are you seeing that process take? I mean.
LHD Michael Fett (21:02) That process can take 60 to 90 days, I mean, because, and here’s, the thing is it depends upon when you get all the information together to submit it to the plan. Because most of the plans, they will only have a credentialing committee that meets once a month. So, let’s say they meet on the twelfth of the month and they’re going to say, well, you have to have everything in by the fifth. Well, if you didn’t get everything and you submit it by the seventh, that means you’re not going to be heard at the credentialing committee meeting on the twelfth of that month. It’s now going to be the twelfth of the following. So you’re now well over 40 days out again from when you submitted it. And then of course, what is the effective date? Is it effective, the date the committee agrees to it? Or is it effective the first of the next month? When is it effective? You know, that’s the problem. Each plan does things just a little bit differently.
Zo Hooda (21:59) Yeah. And like you said, if that person leaves that’s handling all of it, then it’s like, okay, where does that domain knowledge go? And what I’ve seen in our customers is that medallion kind of prevents that type of situation from happening because we know everything already. It’s your team is now the quarterback versus the person that’s actually going and executing all of these actions. We know all of the dependencies. We know, you know exactly what these payers require and we do it really quickly. So, one thing I’ll add to your credentialing comment is we make that process also more efficient. So, yeah, we typically see that, yeah, organizations once a month, they have a credentialing committee, that process can be handled in medallion. So, you know, as I mentioned, once we get all of the provider information, we can turn around a credentialing file in one day. We have an SLA to back that. And what happens in our system is that we have a process where, okay, there’s situations where you actually might not need to have this once a month meeting because whoever is a part of the committee in medallion can give their thumbs up or thumbs down. So you can kind of do it asynchronously whereas as opposed to having a meeting once a month where you’re kind of going through each file manually, you could do it asynchronously within medallion as well. So there’s quite a few ways where we could drive more efficiencies and I’d be happy to speak with Dan further to explore this further. But because I know we’ve got five minutes left here. You know, so essentially what I’m hearing from you is that you’ve got this process, it’s manual you’re on excel spreadsheets. And oftentimes it could lead to costing the company in the form of taking a long time to get a provider credentialed even recruiting providers, potentially they quit and you have to go and recruit another provider, but also just waiting a long time so they can be billable. And so I think where medallion can fit in is we get providers enrolled an average of 30 to 60 days. So we can take that 60 to 90, bring it to 40 to 60 and potentially drives, you know, 30 days of improvement that’s 30 days of revenue that’s accelerated. And so one last question before we kind of wrap up and talk next steps is just to confirm your current provider count, you mentioned it was 75.
LHD Michael Fett (24:15) yeah, I would say it’s somewhere around there. I know that we’ve hovered around the we’ve… hovered around, you know, 50 give or take MPS, psychiatrists, family, nurse, practitioners, psychiatric, nurse practitioners. So it’s been somewhere around there. But, you know, the thing is we also have a lot of turnover, right? So that’s part of the other problem that, we have because, in our business in behavioral health, people do turnover a lot. They’re I don’t know why it is, but, you know, we’re notoriously I mean, if you have a 35 percent turnover rate, it’s considered average or good. Wow, you know, we’ve seen turnover rates higher to 45 percent. And, and, you know, sometimes it’s a little bit better for, the independent providers, and the other providers just because sometimes they’re a little older and they’re looking for a little more stability, right? Yeah. And so they want to be able to continue, they like the match they’re getting on their four one K plan. And so to them salary’s not everything, right? But a lot of times, they do tend to bounce around especially trying to see where they can get even more money. But a lot of that has changed over the past year here with the way the behavioral health climate has funding has changed and the one big beautiful bill act is going to impact medicaid. And so there’s a lot of recipients falling off medicaid. And so their amount of bargaining power is going to continue to go down. The other thing that has helped in some states like our neighboring state of New Mexico. They actually allow a psychologist who has had appropriate training to prescribe. So, and of course, psychiatrists are very much against that. But the reason they’re against it is because they right now hold the monopoly on what I call pushing pills. So if you take that away from them then I mean they’re no longer the monopoly and that’s going to drive the cost down because psychologists don’t get paid as much as an MD. A psyd does not get paid like an MD. But yet, if they can still prescribe psychotrophics at a much lower cost, then that’s going to bring the overall salary down for a psychiatrist too. And they know it, that’s why they oppose it.
Zo Hooda (27:07) Yeah, that makes a lot of sense.
Zo Hooda (27:09) I haven’t thought about it that way in terms of like a psychiatrist perspective. So that’s super interesting. But wow, yeah, 35 percent turnover considered average. That’s interesting with that in the industry. Okay. Well, I know we’ve got a minute left. So one detail I just wanted to clarify too is how does reimbursement work? Do your providers, each bill under their own individual npi or is billing flow primarily through facility?
LHD Michael Fett (27:36) Yeah, they bill under their own npi, but we bill them up under what’s called a rendering provider id. So we basically set it up for them, but we’re the rendering provider. I mean, in terms of it’s under their npi, but we’re considered the rendering provider, which means that we’re the one who gets the payment. So we have our npi, we bill under their npi as the provider providing the service. But the pay to provider is the best way of putting it is our npi, our provider id. So basically what it is the provider is assigning their payment to us as their employer, I see. Got.
Zo Hooda (28:26) It, that makes sense. So from an enrollment standpoint, it’s still the same complexity of each provider needing to get enrolled with the payers that you work with. Yeah. Okay. And then you’ve got 75 providers. On average. How many providers are you adding like on a yearly basis?
LHD Michael Fett (28:44) You know, I don’t know, I would say, you know, it could vary, but I don’t actually, I haven’t seen the numbers but.
Zo Hooda (28:53) I.
LHD Michael Fett (28:53) would say we’re probably adding, we could definitely be adding at least 12 12 and a half, you know, there’s turnover and I really haven’t been in the, you know, in the reporting on that because I’m no longer in over HR. So I don’t see, you know, what the turnover looks like in that particular place, but, you know, we have multiple payers here. So we have several payers, several health plans. We’re basically medicaid. And so what happens is we end up taking everybody who’s an independent practitioner, which is a licensed professional counselor, a master’s in social work, et cetera. And then of course, the psychiatrists… the NPS and we credential them with all the plans. So, and then we credential them with medicare as well. So that’s the other piece. So it’s like you may have them looking at, there may be seven different plans that they’re looking at getting credentialed with between access and the health plans, and then the medicare and everything. And so, you know, if, you know, you look at even there were 10 in a year just using math that’s 70 different plans, credentialing bodies. You’re trying to coordinate for 10 people. And then when are they all effective? That’s the other question, are they all going to be effective the same day? When are they effective with this plan or that plan? And so there’s a lot more complexities to all that.
Zo Hooda (30:28) Yeah, no, we definitely are familiar. And I think the other nice thing about medallion is that there’s visibility along. It’s not a black box anymore. You know, as far as an executive checking in, right? You’re going to have that type of visibility to understand exactly where in the process each provider is. And we’ve done hundreds of thousands of like licensing and enrollments. So we have pretty accurate estimations on when these things will be done. But I know we’re three minutes over. So I want to be respectful of your time as far as next steps. I’d love to connect with Dan to just learn a little bit more about the process and get his thoughts on it. But maybe even after that conversation, after I’ve gathered some more information, I’d love to present you like what the business case for, you know, actually exploring medallion even further would be like after I get some more information from like a revenue acceleration standpoint, you know, what does that materially look like for sbh services if we’re getting providers 30 days faster?
Zo Hooda (31:25) So, yeah, I’d love to connect with Dan and then come back with you and just kind of talk about what I’ve heard and where I think we can make a financial impact. Yeah.
LHD Michael Fett (31:34) Sure. Why don’t you send kind of an email note to me and send it to me knowing that, hey, I’ll forward it on. I’ll copy you when I forward it and then we can go from there.
Zo Hooda (31:45) Okay. That sounds good. Well, I appreciate your time, Mike, and thanks for going over with me. I’ll send you that email shortly. Okay. Absolutely. All right. Have a good rest of your afternoon. Sounds good. Yeah, you too. Take it easy.
LHD Michael Fett (31:57) Okay. All right. Yeah.