Transcript
Peter Bosworth (00:00) hi, Jen. Hey, Peter. How are you? I’m good. How are you?
Genevieve Seney (00:05) Good. Did you get your eye checked up?
Peter Bosworth (00:08) I didn’t but it went away.
Genevieve Seney (00:11) Good.
Peter Bosworth (00:14) Yeah, I did like a warm compress.
Genevieve Seney (00:16) Yeah, it really works.
Peter Bosworth (00:18) So, John nielsen is who I spoke with on Thursday. He’s in the waiting room. Stan. Miller is the VP, like market president. He’s who signed the contract. So he’s like the executive buyer. I just got a notification that he’d be joining the meeting, but he hasn’t showed up in the waiting room yet, but I imagine that he will, and I’ll pull up my.
Peter Bosworth (00:47) Screen.
Peter Bosworth (00:55) But yeah, I’m going to let them in.
Genevieve Seney (00:57) Sounds good. Just like I said, just tag me in if you need me anywhere.
Peter Bosworth (01:01) Okay. I might just intro you or let you introduce yourself at the beginning. Okay? Perfect.
Peter Bosworth (01:14) Hey, John. Hey, Peter… how’s that drive going? How far are you?
Jon (01:23) You know, I had a couple of stops, so I’m only, yeah.
Peter Bosworth (01:27) Not.
Jon (01:29) quite halfway.
Peter Bosworth (01:32) Well, I hope you have, a good audio book or something to keep you occupied.
Jon (01:38) Oh, yeah. Yeah. I usually have so many calls during the day during the week that, you know, like you one call after another, and before you know it, you’re there?
Peter Bosworth (01:47) Okay. Exactly. Awesome. Well, thanks for making the time. I thought we could start off with some really quick introductions from both sides, but yeah, I’m Peter bosworth, I’m account manager here at medallion. Obviously, John, you and I connected on Thursday and just here to kind of help guide the discussion around, right? Sizing the contract and I’ll let Jen from our side introduce herself.
Genevieve Seney (02:13) Yeah, it’s good to get to meet you both, John. And thanks so much for joining. You. See you’re driving there. But my name is Jen, sini, I’m a manager on the account management side. So just joining Peter and, you know, helping out, jumping in on any questions that might need additional context, but pleasure to meet you both. And sorry, I didn’t catch miller. Is that your first name?
MillerStanford (02:36) No, stanford.
Genevieve Seney (02:37) Stanford. Okay, great. It’s a pleasure to meet you.
MillerStanford (02:40) Nice to meet you. And.
Peter Bosworth (02:42) Stanford. Do you mind doing just a quick intro?
MillerStanford (02:46) I head up the U. S, operations for neurocare? I’ve been in the business for probably over 25 years in this space in neuromodulation and, you know what we do as a company, not only, you know, in the clinic side, but also on the technology side.
Genevieve Seney (03:07) Great pleasure to meet you. Yeah.
Peter Bosworth (03:10) Great to meet you. Thanks for jumping on. So my quick agenda for the call is just want to recap really quickly. The discussion that John and I had on Thursday, go into kind of some of the projected numbers that John and I arrived at and explain why, and then see if you have any questions on the proposal that was shared and then discuss next steps. Is there anything that you would like to cover in addition?
Jon (03:42) Yeah. I mean maybe if I could just add some color for you first because… when we originally, you know, how we got to this point just so everybody’s on the same page. You know, when we were initially meeting, you know, James and I, James chigano and I were on calls with Connor and there was another gentleman before Sandhya got involved.
Jon (04:07) I forgot his name. Sorry about that. Regardless. You know, we were going over and kind of getting an idea of what we would need. You know, at first we thought there was a potential that we may not be large enough of a group. Then we thought, okay, you know, with everybody that we have.
Jon (04:27) And then, you know, potential growth, not what we need exactly right now but potential growth in the future that it might make sense. So we lined up all those based on, you know, what the medallion team, the feedback they were giving us. Then when it came time to actually see the breakdown, you know, Peter, as I was explaining to you last week, we’re seeing that there’s only 10 caqh management credits in the package, when in reality, we need 100, you know, so significant difference. You know, initially I checked with James after we met Peter, he was in agreement. You know, from the initial information, we didn’t feel that it still feels like there’s some confusion around nurses. So, RNS, lpns, et cetera, when you bill for them and caseworkers or case managers, cause I had heard like, you know, that wasn’t something you guys have done before don’t normally do. And then, you know, thinking back to those original calls that the caseworkers and RNS even though they, you know, they have a spot which makes sense. They have a spot on the platform so they count. But when we were originally discussing, that wasn’t counted. So then there was the, you know, the proposal… and, you know, it’s very expensive. You know, to work with you guys. And then as we’re rolling out the Ohio clinics which is our largest entity in Columbus, Ohio, which has five clinics, you know, the staff there is kind of revolting over having the management to manage the caqh and ongoing credentialing for the providers, when the group we had prior… we were seeing… it as a step back now, you know, with the added cost, you know, it’s looking more like this is something, you know, that we want to unwind… than add because, you know, I mean, I want to get the breakdown of what you’ve added to it and see the delta between what our initial cost was and what it would be now. But, you know, if we have any other projected growth and then adding credits as we go, you know, because as I also mentioned last week, I just don’t have the bandwidth for the people at the clinic to really manage this stuff. I’m going to rely on whoever the credentialer is to, I really need them to like essentially do everything… right?
Peter Bosworth (07:19) Right. And that is kind of what I wanted to show on this slide, which is just that really what we’re looking at here is this purchase number is the items that are included in your contract. So it’s 70 provider seats, 70 ongoing monitoring for those providers, and then caqh management. So just 10 credits as you mentioned, and then 144 payer enrollments. And so the totals… that you were looking for were 100 to cover all the different providers. And… so that would mean and 250 total payer enrollments. So that would mean adding 30 for core 30 for comprehensive monitoring, 90 for caqh management and 106 payer enrollments. So that is what I sent over on Thursday. Did you have a moment to look at that contract? I?
Jon (08:17) Did I, did, I saw there was, I think it was year one was 100,000, and then years two and three. I thought the number was 32 for each of those years. So without having it in front of me, can you maybe explain the, you know, what would be the delta between our original number and what the number would be now?
Peter Bosworth (08:47) Yes. So your original contract is right here. And so… the total, the subtotal for year one is 60,000, 125. This includes the 10,000 dollars for implementation. So in terms of like contracted services excluding implementation, it would be like 50,000 dollars worth of medallion services. And then the, based on, you know, these adding these projected needs into the… agreement… I just added them here in each year because you’re in a three year agreement. So it’d be 32,000 additional or 34,000. We’re prorating these two SKUs or these three SKUs, because they are priced per provider per year and we just prorate them based on the day that the providers are added to the platform. But to answer your question directly, it’s an addition of 34 Ish 1,000.
Jon (10:01) For each year for three years.
Peter Bosworth (10:03) For each year, for three years… I’m sorry, go ahead. No.
Jon (10:12) So then total cost each year is approaching or eclipsing 100,000.
Peter Bosworth (10:19) For year one, it would be 92,000. And for years two and three, it would be 84,000. Yeah.
Jon (10:34) Yeah. So that’s what I was concerned about because it was, you know, it is the management of it is significant.
Jon (10:45) Yeah.
MillerStanford (10:46) Yeah. So the bottom line here is I think we need to unwind this contract because it’s just not cost effective for us. You know, at the end of the day, we’re a small company and, you know, we still have to do so much work and, you know, we could for that amount of money, we could hire a person dedicated just to do all this for us and do all the work, not just part of the work. You know, if I were to hire a W2 to do this, right?
Jon (11:16) So, our current group in Ohio, the group they’ve been using for some time now years they charge them, you know, they charge them about 1,200 a month. It’s just for Ohio. It’s not, it’s not our other entities… you know, and they manage it like they basically, they get it together and they hand it to them and go, okay. Here you go. So, the original motivation… for this was to try to get everybody in our group in one place for credentialing… but there’s just, I mean, it’s such an extreme like Stan saying, it’s such an extreme cost difference from what we’re doing now and, you know, you’re mentioning that we’re paying for, we do bill for them, but it’s you know, it’s medicaid billing in the state of Ohio. It’s it’s case management and some therapy. You know, a lot of them, there are some doctors and nurse practitioners, but a lot of them are these lower level people that you do get some reimbursement for, but they’re just not, you know, it’s not huge margins. There is turnover with, those lower tiered employees. So it really compounds for us with this model for credentialing the cost.
Peter Bosworth (12:47) Right. And just for context, like the way we backed into this 106 number was just that, you know, John had shared that it seemed like 144 enrollments was an undershot estimate on how many enrollments you would be doing for your provider network.
Peter Bosworth (13:09) So the discussion was just adding more. And then caqh management. It sounds like that was a really high priority like wanting to offload that the burden of that work to medallion which we are obviously very capable of doing.
Jon (13:23) And,
Peter Bosworth (13:23) then getting those other providers into medallion, so we can be the system of record for them. So that’s why we’re adding these first two. This is just provider seats.
Peter Bosworth (13:37) But yeah, it sounds like there’s the concern is just the, what is the main concern here? Just.
Jon (13:48) number one, it’s just, it’s too expensive for us, the size of the business. Number two, if we were at our prior price point, you… know, the Ohio staff had been concerned with just some of the discussions and feedback around some of the types of providers again seemingly not the normal situation. And then if I try to use more of our internal team members to work through some of this stuff. So we’re not going up an exorbitant amount for us at least then… you know, I have a lot of very disgruntled employees. Like it’s just, I mean, it’s the, it’s a combination of, you know, the calls, not really. It just has a, you know, a feeling of uncertainty and then with the cost on top thing, I just, I frankly, I, there’s just no way for us to do it… right?
Peter Bosworth (15:12) Well, the, I mean the reality is we, this contract was just signed. So there’s plenty of runway in terms of the number of enrollments that you have. And so what we can, what we can do is just, you know, monitor your consumption as the months go on. And as you start submitting enrollments, and getting providers onboarded, and… you know, you have full visibility into the platform in that by the way, how you’re tracking against the contract and all of that. But we can just, you know, reach out there’s. No, we… can just kind of reach back out when that needs to happen. So… yeah. Does that sound like a good plan?
MillerStanford (16:00) No, no. We’re saying we have to unwind this. This is not working for us. It’s taken even just to get started. Here has been a huge lift for us and, you know, nothing’s really actually come out of this. We’ve signed this contract and we don’t have anybody being credentialed, you know, we, we’re just trying to get onboarded here. It’s just been a huge lift for some reason and I know that’s just guys how you guys work, that’s fine. But it just wasn’t envisioned to be this by us. You know, it’s you know, it’s much our fault. You know, we maybe didn’t I don’t know if we didn’t ask the right questions or whatever, but this is just not going to be a fit for us. So what we have to do is unwind the agreement, yeah.
Genevieve Seney (16:47) I guess I can jump in here and I think apologies, it sounds like there’s definitely been a misunderstanding of what the intent was for this discussion and sort of where you guys are today. So from our perspective, right? Like kind of point of today was to talk through additional potential needs. Sounds like that’s actually not at all the direction your team feels or is headed in. So I think like from our perspective, right? Like obviously, you guys have a three year contract myself and Peter are not assigned to this account or working through this. And so it sounds like there’s maybe an intent to obviously talk through frustrations, talk through what’s not working and kind of a path forward there. So we can definitely readjust internally. I think it would be helpful from myself to kind of get the right folks involved here, John in stanford. Has there been any other communications or emails sent with the intent to sort of not use these services or was that stated on a previous meeting?
Jon (17:50) No, not yet. You know, we were trying to first, we were trying to get, right? Just.
MillerStanford (17:57) You.
Jon (17:58) know, what actually made up a contract or what all went into it? That was the call with Peter last week. So we could see, because again, once I saw last week was the first time I saw that 10 number. And that was the kind of moment where, you know, I believe it was Thursday last week. Maybe it was maybe it was earlier in the week, I’m sorry. But when we were on the call with Sandia and Connor and they showed the actual breakdown and I saw that 10 number for caqh management and the rest of the team goes well, that’s gosh, like that’s not, you know, that’s never gonna fly. So I wanted to see what, you know, additional cost would be. And now, you know, like I said, we were at our limit with the initial number. This is, I mean, this would put us into a really bad spot. Yeah.
MillerStanford (18:58) See that’s the thing, right? Is we thought we were going to get what we needed with the original number. And now we’re talking about, you know, like a 70 percent increase, you know, right? And, and we understand, but it’s just, it’s like I said, I could hire somebody who just did this and did all the work for the amount we would be paying you and we could have it done for all our clinics, right? And, and, you know, you have a W ii employee just as well. They do, right? It’s it’s just, it’s not tenable for us at this point? Yeah. And.
Genevieve Seney (19:32) I think, I mean, I guess like obviously pricing being a concern, you guys have only consumed your implementation fee so far to date. Do you have an idea of when you anticipate I guess the growth of the remainder? Because in my mind, you have, you know, let’s call it 160,000 dollars worth of spend. And so like I don’t foresee this, I guess you over stepping on your contract in the near term. I think like obviously discussions down the line of how you want to use it, you still have the three years worth of spend and you have skew flexibility so you can push and pull your contract value between product lines depending on how you’re tracking with your needs throughout the partnership. And.
Jon (20:20) So, I think, yeah, I mean, yeah… it’s kind of, you know, as opportunities present themselves. But then comes, you know, my job is to be a mediator of sorts, with a new group and get the two groups to mesh and work well together. And when I go into a new group now and have to… have them do this process, it’s just, I don’t even feel comfortable asking a new group that we’re just starting off to work with to be responsible for it. The people that I work with now, I know enough about their background to know, you know, what their capabilities are or not or what their bandwidth is. I don’t know that for new groups. And just, you know, from what I’ve seen up until this point and the feedback I’ve gotten from the Ohio team, you know, maybe there’s some groups that are set up for this and can do this very easy. Ours is not. And that’s what I was saying on the beginning of the call, we, you know, what we actually need is more of an individual or if you’re you know, like hypothetical, if your group had an individual that said, okay, you know, I’m your point person. I’m gonna collect this information and make sure it’s good on… you know, the platform and, you know, and then we’re gonna get started for you guys and we’ll be ready to go. You know, at least with your first group of providers in a few weeks, that might be a different story. But that’s it’s been a very different experience. It’s you know, it’s just hasn’t been a smooth implementation… and.
Peter Bosworth (22:11) just sorry, one quick question on the implementation, like, has the issue been completing? Like the data import template or something different? I.
Jon (22:22) Think it’s just, the whole process overall. With the main points being, you know, in Ohio, we do medicaid, we have case managers, and nurses, not nurse practitioners, nurses that we do bill for through medicaid. And there’s been some disagreements on the call between the mid, Ohio team and the medallion team as far as, you know, how those people are set up and kind of what they’re able to do. And, you know, it kind of comes to like, okay, well, we’ll work that, you know, we’ll see how that goes but not a definitive like, yes, I understand that this is how this works, this is and that was one of our original problems too, you know, with, when we were counting up providers with Connor and that other gentleman initially, you know, we explained kind of… but… we were, and that’s… how we get the numbers and then realized after the fact that it actually needs to be all of these… employees that not just.
MillerStanford (23:44) Across all our networks, we have very few physician and physicians, right? We’ll have like one medical director for managing, you know, multiple clinics, for example, right? So we don’t have a lot of physicians, but more physicians. Unfortunately, it’s hard to get them, you know, getting physician time is hard. So we don’t have that. It’s not the situation for us. We have mid levels of different tiers. And even below, it’s just that we got these case managers, right? But they all have to be done… but we just don’t get much revenue out of those people, right? So to pay for an expensive service, you know, for very little revenue is not a match. Yeah, I think like.
Genevieve Seney (24:37) I said we can take this back and kind of understand, I guess from our perspective, right? Like in terms of next steps here, like obviously I can loop back in your implementation team. Again, you are in a three year contract with us. So it’s not just kind of like a term for convenience is not something we do. And so I don’t you know, from our perspective, I can definitely loop back in the implementation team and try to readjust and where you guys are looking to head with the partnership. But I don’t know from your perspective, what your next steps might look like maybe is a better question?
MillerStanford (25:19) Like if.
Genevieve Seney (25:20) we talk like price aside, right? You obviously signed the contract for the three years. What would make the most sense of like how do we make this partnership work? I guess is where I would focus the discussion with our internal teams and implementation. I know you’re working with Zendaya. So that’s kind of the next steps in my mind, but I want to just make.
MillerStanford (25:39) sure, yeah, you’re going to have to bring us a different way to work because what we’re doing is not working and I don’t know if you have the capabilities to do that. Again. It’s just the way your system is. I don’t know if it can do the job for us, right?
Genevieve Seney (25:57) Yeah, sounds like maybe just some misalignment with the amount of kind of requirements that we need from the partnership upfront, and then also ongoing things like tasks and data provider management of collecting that data. It sounds like that was probably something you were looking to have done or outsourced, which is definitely a big part of the partnership. And obviously, there’s ways around that in terms of inviting the providers and having them manage their data entry and so on. And so forth. I think it sounds like from what the feedback was, that might have been a misalignment originally.
MillerStanford (26:33) Absolutely. Was.
Jon (26:34) Yeah, if I would have known ahead of time like, you know, it was said a few times like, hey, there’s you know, there’s stuff on the front end, you know, we got to collect all this stuff, but once we get it and then we’re good.
Jon (26:47) I’ve had two very experienced people that are very familiar with this clinic each spend, you know, 30 to 30 plus hours on this project. And when we were looking at the providers for mid Ohio last week, it says it’s 28 percent complete, which is like, you know, and when I asked the employees there, which… again, not new employees, very knowledgeable. They’ve been with the group for both of them over a decade… and they know billing, they know enough about credentialing to collect information. They’re kind of like throwing their hands up. So, I just, I, you know, I’m not a credentialer, I don’t know how to solve it. Yeah.
Genevieve Seney (27:38) Okay. I understood. I definitely hear the feedback. I think like I said, from our side, I think we were just misaligned with what today’s discussion was centered around. From my perspective. Like I said, you guys do have this three year contract. You’ve only spent 10,000 dollars worth of spend today.
Genevieve Seney (27:54) We can absolutely turn on caqh management for all 70 of your providers. Obviously, that will take away from the contract value as you start to submit requests and use the platform. But again, I don’t see a need to sort of add more dollars to this account so far especially with the sentiment and where you are today. So that would be my recommendation but I’ll have Sendai and the team reach back out to schedule a call and decide what next steps look like from there.
Jon (28:22) So, is Sendai that’s who’s going to… be working on that going forward? Yeah?
Genevieve Seney (28:33) So it sounds like, I mean, I don’t know how, I just am not familiar with the project where you guys are. I know Sendai and Connor were working together with you to kind of talk through obviously like implementation and getting up to speed. And so either one of those folks will be reaching out to schedule next steps of where you guys want to go… okay?
Jon (28:56) All right. Awesome. Well.
Genevieve Seney (29:00) I appreciate the time today, guys. Yeah.
MillerStanford (29:02) Like, you know, unfortunately, I know you guys kind of got thrown, into the quagmire here. But when, you know, when we saw, OK, how much is going to be more? You know, just to get maybe what we need. And it’s taken so much time even on top of this and to think that we’re you know, in this and we’re you know, 28 percent done and, it’s just really amazing.
MillerStanford (29:25) Mind boggling because this was not the way it was pitched to us and maybe we didn’t understand correctly, but it’s just, it’s not going to work. Yeah.
Genevieve Seney (29:40) Yeah, understood. Yeah, I know. Agreed. We obviously weren’t part of those discussions.
MillerStanford (29:45) Yeah. So it’s not your guys fault. I’m just, this is just the reality is where we are.
Genevieve Seney (29:50) Yeah, yeah, yeah. Agreed. I think like we could definitely get to a better place in terms of where you are today and how we’re processing the work. Like I said, there’s always going to be a need for additional feedback and provider engagement from the partnership side. But in terms of actual enrollment credentialing work, I’m fully confident in our teams, but regardless, I will give them sort of the feedback and where we landed today and they’ll you know, sort of reach back out and hopefully get things back on track. Like I said, we don’t it’s not, we wouldn’t just kind of like terminate in the contract. So I think like again, there’d be more discussions around this moving forward, but we will reach back out and schedule next steps.
Jon (30:34) Okay. I’ll keep an eye on.
MillerStanford (30:35) It. All right?
Genevieve Seney (30:36) Okay. Thank you guys. Thank you. Thank.
Jon (30:39) You take.
MillerStanford (30:39) Care.