Transcript
Matt Vail (00:00) hey, matt. How are you? Hi, Mira. Hey, I’m great. How are you doing? Doing?
Mira Guha (00:04) Well, it’s been a minute. Happy school.
Matt Vail (00:07) Yeah.
Mira Guha (00:10) Totally nuts. Awesome. Well, I want to make the most out of your time. I know you’re busy. I went ahead and made some updates from the deck I shared last week two weeks ago. I’m happy to go over those and also just focus on any places where you had questions or wanted clarification?
Matt Vail (00:28) Sure. I honestly do not remember what was in the deck. Do I have it where you emailed it to me? Is that right? I’m so sorry?
Mira Guha (00:40) I believe, so that’s okay. I’m on the same boat. I don’t remember what yesterday was about monthly.
Matt Vail (00:46) Am check ins. Yeah. You know, if I didn’t write it down in my notes, then I’m like completely useless. Let’s see. Okay. Yeah, you sent it to me eight days ago. Let’s pull it up. Okay, cool. Good, good. I’m just going through it now. Okay. Yeah. Okay. I don’t think I have questions on this, but I think it would be great to talk through how it’s working right now and how we can do better. Yeah.
Mira Guha (01:24) Absolutely. I think then in that case, it would be helpful for me to just like jump ahead if you want. I can go over these. It’s really not that much of a difference of like here’s where we were last time I sent it to you here’s. The new version, pretty minimal changes. But to make the most of our time, it sounds like just doing a quick check in on like, hey, what’s going well? What’s not? And then we can revisit that every month that we meet. Assuming we can do a monthly meeting. We’d love to.
Matt Vail (01:48) Yeah. Sounds good.
Mira Guha (01:50) Yeah. Happy to just make this kind of an open conversation and hear from you what’s working, what’s not?
Matt Vail (01:56) Yeah. So let’s start with new provider onboarding. Obviously, we went through a period where we just had one provider, our CMO and that was fine. Frankly, she experienced a lot of friction getting onboarded and I was pretty surprised. I, when I signed up what I feel like I was pitched on was, hey, your provider inputs their npi and caqh numbers and we do the rest like that was the pitch and that… was very much not what we experienced, which… is okay. I get it. And Nikki our CMO like worked through a bunch of friction there.
Mira Guha (02:52) I.
Matt Vail (02:53) Don’t know. Do you know, kind of maybe let me take a minute or two and explain our business model because I don’t know that we’ve really shared it so well. Yeah. So we’re building an end to end operating system for private practice. Okay, part of that is, you know, we want to do PSV and credential providers on our payer contracts so that they can run their practice but bill insurance under our tax id, so that they don’t have to go through this whole thing by themselves. Okay. So, our customers are these providers… when I go like win a new customer, I have them sign, you know, sign their contract to work with us. And initially, it was like, cool, all I need from them is npi and caqh because medallion then handles it, right? So, I, you know, I’ve got that. I come in, I try to onboard and I start getting messages that are like, oh, actually we need social. Okay. I go back to my customer and say, hey, I changed your social. Oh, actually we need caqh login. Oh, actually, we need them to fill out. We need them to send a picture of their driver’s license. Oh, actually, we need them to sign this agreement in the medallion platform. And so, it is starting to become extremely… high friction for me to onboard a new customer. And so that’s what I like that is my number one pain point that I’d love to figure out full stop is like, how do we reduce the friction of me taking a provider customer and onboarding them? And already I’ve on my side like I’ve, just started to capture more data upfront so, you’ll see in here. I recently added Toyin and Mandy… they’re both customers they signed, you know, this week and last week. And for them, I thought, oh, great. Like I got a bunch of info from them. And then I pulled a bunch of info from their caqh. And I’m still getting messages from the support team being like, yeah, you’re at 20 percent or whatever. And I’m like, wait, why does Mandy have to sign agreements with you? She already signed them in caqh, what we talked about was like our customers, our providers would never even need to log into medallion. So that’s yeah. What I’m hoping we can focus on today? Yeah.
Mira Guha (05:21) I apologize if there was any miscommunication in our process. Excuse me. I know I was only able to join part of the kickoff call that day because I had a conflict. So I wasn’t also there for a pre sales conversation and that the reality is, yeah, we can use caqh to help populate a decent bit of the profile. The exact percentage really varies from provider to provider… but that will not cover everything. I think on average, we’re seeing that caqh if we can pull in everything that’s in there. Assuming there’s a good bit in there, we’ll complete like 60 to 70 percent of the profile won’t cover like some of those documents for general identification, like the driver’s license that you mentioned. Yeah, the cqh I think I remember talking to Connor about this was, we need the login and, or the social security number like that’s. Kind of changed in the time I’ve been here. It’s never been like super duper clear which one we need, whether we need one or the other. And then from there, we still need to task out for these things. And then the big thing being the provider release, that is something that every single provider we’re doing any work for, they have to go in and basically sign that attestation that gives us permission to do the work. And I think for liability’s sake, ensures that everything that is in medallion is accurate and up to date. So that should have been something that was discussed in the sales process initially or just kind of that onboarding process. So, I apologize if there was any miscommunication there. I think what you said, you’re doing to try to get as much information upfront as possible is definitely a good way to try to get around that. I don’t remember if like Connor or anyone on the sales side or on our side might have sent you that provider welcome packet. We have that kind of just gives people, an idea of what to expect once they’re added to medallion. But the reality is we do need them, to interact with the platform at minimum to sign that release attestation, if not, you know, helping provide some of that information.
Matt Vail (07:15) Got it. Okay. So it is what it is. I have not received any materials. So if you want to send that to me, that’d be great. Yeah. And then, you know, I can use that to try to make things faster and smoother. Maybe a related question. Do you guys have an API that we could integrate with? We, do, my providers are already logging into my platform. So can I have them do all this stuff via API from my platform? I?
Mira Guha (07:47) Think so. I’m not an expert in our API. So, I think the best thing I can do is just send you. I have a document that’s like an overview of how our API works, and then the technical guide that’s actually like here’s, how to set it up and how to run the calls.
Mira Guha (08:00) So from there, if you have questions, one thing I wanted to clarify, I know we were working with Connor. I don’t know how often you were meeting with him. And now that you’re out of implementation, if you’ve worked with Shannon at all, but you do have that day to day operations contact and it might be really beneficial even if it’s like monthly for you to do a check in with Shannon. She’s great and she can kind of help, maybe think about best approaches to some of these practices. And if there’s other resources we can provide you, she can do that.
Matt Vail (08:28) Yeah. So, I don’t know that, I maybe met with Connor once. I don’t think he did. He was not very, instrumental to our setup, but I talked to Shannon twice and Shannon was wonderful.
Matt Vail (08:43) Shannon actually unblocked stuff and got it moving. So, like, yeah. So if you think it would make sense for me to have a regular cadence with her super happy to do that, she was great. Yeah. Okay. So, so you’ll send me the provider onboarding, you’ll send me the API documentation. I’ll have a look at both, and think through, next steps. I guess in terms of… yeah, I sort of feel like I need to review those to ask the right questions. What I’m like, I basically, I’m like, okay, you know, we’re all in using you guys. So that’s great.
Matt Vail (09:20) Now, I just want to like map, I want to optimize the workflow so that we’re successful, right? So, like I want to figure out how do I get Toyin through the PSV process like ASAP? And it sounds like at least in the immediate term, I need to get her to log into medallion and fill stuff out until she’s at 85 percent inclusive of necessarily the agreement at the bottom. Is that a good summary? Yeah.
Mira Guha (09:51) I would say so, even just having her sign that first will probably be like the fastest way to help unblock things. And then, if, you know, you want to leverage and you can leverage our API to help populate other parts of the profile, that’s a brilliant way to do it.
Matt Vail (10:07) Okay. Yeah, the API will be something I’ll have to figure out like, how difficult will it be for us, to build out? Like in my ideal world, we would basically, we would build one UX for, in our platform that has the absolute minimum required data for.
Mira Guha (10:29) You.
Matt Vail (10:30) guys to go do your work because one thing that’s difficult in your platform.
Matt Vail (10:34) And like Nikki had this feedback, she’s like there’s like a 1,000 fields. I don’t know what’s required versus like what they just would like to have. So, she’s like filling a bunch of stuff out. And then it’s like she’s filled out 100 things, but it tells her it’s at 50 percent and it’s because it’s the 100 and first that’s required. So, what I wanted, like what I would do on our side is like just required fields.
Mira Guha (10:58) But I have,
Matt Vail (11:00) to read the documentation and see like how long would that take me to build? So for now, I think we try to prioritize like let’s get Toyin and Mandy through the PSV process. Also, Nikki has like 12 licenses that.
Mira Guha (11:16) this.
Matt Vail (11:18) Is a related but separate thing. Like… I was basically sold that, it was kind of hands off like put the data in and we’ll do it. We’ll do the license. And Nikki comes in and has like 10 tasks every day. It’s like, you know, I don’t know who. Yeah. Okay. So, so she also is blocked on a bunch of licenses and I guess the takeaway is like, yeah, she’s just got to come in and spend, you know, eight hours to update stuff.
Matt Vail (11:48) Maybe there’s nothing really to discuss there if that’s the case. But it does certainly feel like a lot of stuff that we thought would kind of get handled is like getting bounced back to us, yeah.
Mira Guha (12:03) Yeah. Again, I do apologize. If that was not made clear. I think something that would help is we have this stack again, something probably should have been discussed earlier on when you were kind of in the pre onboarding process. I can kind of fortunately only so much we can do now that we’re here. What I can go ahead and do is clean this up based on the type of work we’re doing for you. This page in particular I think is pretty helpful at giving you an idea of for us to complete intake to basically start working on a this is specifically enrollment application. These are pretty much always going to be required at the bare minimum if we’re doing medicare medicaid, certain things are going to be a little bit different. But for the most part, like this will give you a sense of what’s absolutely needed. I think similarly for licensing list of things that we’re always going to need. And then we also just kind of have our little workflow chart that’s like here’s, how it works. You make the request, we need the profile completed to sometimes arbitrary depending on the state board, the payer, we’re going to 85 percent. From there, we make sure that looks correct. We create tasks. If we’re missing anything just to help kind of make sure that all makes sense. And then if there are lockers or barriers, we’re noticing especially trends in the process. You and I as well as Shannon for the day to day can kind of start attacking those and seeing how we can streamline for efficiency.
Mira Guha (13:24) So hopefully that will kind of help us going forward again. I apologize that it took us like having all this friction to get here.
Matt Vail (13:32) Yeah, it’s not your fault. And I get it at this point like, yeah, just trying to figure out how to, you know, make it work as effectively as possible now. So it’s all good. It’s all good. This deck seems super useful though. So that’d be great. I’ll go ahead.
Mira Guha (13:48) And I’ll clean it up and send that over as a separate option for you to review. And then if you have questions, just let me know, let Shannon know we can go from there.
Matt Vail (13:57) Cool. And do you guys, like, are you guys open to doing a slack channel? Like I’d love to just add you, Shannon. And if there’s a technical person on the API like put the three of you in a slack channel and then I’ll be in there with our CMO and then we can not like have a bunch of email threads. Is that something you’re open to? I’ll have to?
Mira Guha (14:16) Check internally. I know last time I checked that’s not something our team is open to doing as a client facing a slack channel. So we, at one point we were doing them, we had to eliminate those. I don’t know that we’ve made any exception to that since, but I’ll definitely ask and see. Okay, sounds good… but you are always welcome to email me and if there’s ever anything urgent, I’m happy to share my cell with you if that helps too.
Matt Vail (14:44) Cool. That sounds good.
Mira Guha (14:49) Okay. And I think like, yeah, setting up a recurring call with Shannon will be good. Yeah.
Matt Vail (14:56) That’d be great. The one thing on the payor contracts that seems to be a consistent pain point is I need to do this like medicare delegate… authority thing to you guys and this is totally crazy to me. But like I have like a CMS application to change my role to like an authorized official and it’s pending for like weeks, which is insane. I’m assuming there’s nothing you guys can do to bypass that or like I’m just like, yeah, exactly the surrogacy thing. It’s like stuck waiting for them yesterday. I got a notification that said they want me to call them with my wife to tell them that I am actually a member of the practice. It’s all like crazy wild. But anyway,
Mira Guha (15:44) never heard that with.
Matt Vail (15:45) My wife because I’m the only employee of the practice, so they’re like you can use a family member to confirm your identity or whatever. So, okay. But I mostly bring it up to ask. Is there anything you guys can do to streamline that? Or like that’s? Just, it is what it is and I just have to go deal with them the last?
Mira Guha (16:06) Time I saw anything remotely like this come up where they’re like the authorized official or something exactly. Yeah, exactly. I had a situation a couple of weeks ago with a client and they like the person who had that title at their company left and never transitioned it over. So they were trying to find someone to take on that role. And we were stuck for a really long time because there was only so much we can do. I think it’s worth having Shannon or someone on our ops team take a look to see if there is anything we can do, but if it’s like identity authentication or something, unfortunately, we might be stuck waiting for the medicaid side of things. Is that like for Pecos or?
Matt Vail (16:44) I don’t remember, but there’s so we are enrolling in medicare and so we have, I think 15 states or whatever. So 15 of these all of which require the surrogacy. But then those 15 are blocking another. I don’t know 30 because there are these payer contracts that are, you know, commercial aco, and medicare all in one and.
Mira Guha (17:05) We can’t.
Matt Vail (17:06) get that payer contract until we can show we have a medicare number in the state. So, yeah, it’s just like a cascading nightmare with CMS. So, yeah, if Shannon has any suggestions there. Great. Otherwise I’m going to try to get on the phone with them. Hopefully tomorrow morning, I just got this email yesterday. So, yeah, hopefully tomorrow morning and go from there. But if Shannon has any advice, that would be wonderful.
Mira Guha (17:33) I’ll go ahead and I’m going to relay all this feedback to her after our call and I’m going to copy her on our email so that she can set up some time with you soon. It doesn’t have to be recurring but I think it’s always helpful kind of like for us to have something on the calendar even if we cancel every once in a while.
Mira Guha (17:47) Yeah, I don’t know if she might have any recommendations, totally hear you on the blockers. I have a client who decided to remove like any medicare medicaid lines of business from their commercial lines and then just add them in later. But unfortunately, that is more work and more cost. It’s worth it. Yeah. So something to think about that will also affect your medallion costs. I want to just be clear about that if you do demographic updates and then stop and start, it does kind of affect that bottom line there. But let me see if she can take a look and if there’s anything she can help with if she doesn’t like if we don’t have the surrogacy, and we can’t even take a look that’s one thing. But if she says like I had a client where this happened here’s, what we did, maybe that can at least push the needle a little bit, but I’ll see what she says.
Matt Vail (18:31) Cool. Thank you for that. Yeah, of.
Mira Guha (18:33) course. Anything else? I think this is all really helpful feedback and hopefully something we can at least make a little smoother going forward.
Matt Vail (18:50) I think that’s all of it really. I guess. Yeah, maybe one other thing is I am having a little bit of a hard time just with the UX of the tasks. Like in some cases, I see that I have, you know, 50 that need my attention. I click in and I just don’t always even know what attention I should give it or in some cases, it’s like you need three providers in the state to enroll in this payer. And so like I just reply to it. I’m like, yes, let’s revisit when we have three providers in the state or something like that. And I like it’d be good if there was some better way of communicating that type of thing. Yeah, it’s not like a great for me at least like a great user experience to go through the tasks. I’m not sure that there’s really anything actionable in there for you, but.
Mira Guha (19:41) Yeah. I think that might be a good thing to talk with Shannon about. Some tasks are going to be automated depending on what’s currently happening in platform. Some tasks are going to be assigned to like admins versus provider. Sometimes if you would like us to action certain tasks a specific way, like, hey, whenever there is something like a provider minimum, can you send this type of task and like use this verbiage because then I know exactly what to expect depending on if that’s one that’s automated by our system or sent by a specialist. If we have kind of that project plan that says, hey for vye health for this kind of task, please proceed this route or only assign to this person. Sometimes we can go ahead and customize that for you. So if that’s something where it sounds like maybe there isn’t a ton we can do right now, but it’s kind of an ongoing thing to keep an eye on is just how we’re tasking. And if there are places where communication is slow or the actual exact ask of you or your provider is unclear, we can kind of reframe that Melody as well. As sometimes some specialists are going to phrase things a little bit different than others if it’s being put in manually. But of course, if that’s like creating further confusion that’s something that we want to flag internally. And if that means retraining or just making sure that specialist knows, hey, for this project plan, do this definitely some feedback we can take internally and make sure we’re acting on going forward. Cool. Sounds good. I.
Matt Vail (21:08) think that’s everything okay?
Mira Guha (21:11) Okay. We can always revisit that in our future meetings. I’ll just pull up like, hey, here’s, what we talked about last month, have these improved at all? Are these getting worse? Is there anything new? So for posterity, I’m going to kind of keep this deck running. And then each time we meet, I’ll kind of update. But as far as just kind of anything, we should maybe be aware of whether it’s the next few weeks, months, whatever. Sometimes it’s helpful if we know any big plans on the vye health side. If there’s anything that needs to be changed or, hey, we’re going to have like… the platform in two weeks, any priority states or plans, things that we should be focusing on that we know are going to be like high priority for you. I’m happy to take a note of those and relay them again to Shannon or other folks on our team. Otherwise I can just kind of, I know we’re coming up on time, spend that time wherever seems most valuable to you. Yeah.
Matt Vail (22:01) So, I’m happy to give you sort of an update on our plan for the next six months because I do think it will be highly relevant here. Right now. I am recruiting a cohort of 10 founding clinicians to build practices on our platform. So I’ve signed two of them up. I expect I’ll have roughly another two per week for the next four weeks including this week. So we’ll get to 10 by end of may… and with all of them, I’m trying to get them through PSV and then start enrollment with payr contracts as quickly as possible with all of them.
Matt Vail (22:35) I expect to also submit additional license requests… so additional states… and basically try to push all of that as quickly as possible. So we’re going to accelerate a lot over the next two months in addition between now and the end of September. I am aiming to sign an additional 100 clinicians who are non binding, committing to being represented as part of the network, which means I will put them in the platform. I will take them through PSV and then we will likely stop there, but maybe we will go through enrollment depending upon, you know, what changes. But so, so my goal is to have 110 providers by end of September. So a lot more volume. And like I said, for the second one, for that 100, there, it’s like let’s get them through PSV as quickly as we can. Which again, I expected that to be like frictionless. Yeah, it’s clearly not. So whatever we can do, to like streamline. And if that means and I’m happy to show you. Like, so I get this Loi, I can send you the template I use. And if you’re like, oh, include whatever I don’t know, like for me, I’m like going through and I’m like, I don’t know why we care what their birth city is. But apparently, that means that I’m only at 60 percent instead of 80. Like if birth city is going to make the difference, I’ll include it on the Loi, you know. But that kind of a thing like auditing my Loi against the platform requirements, which might just mean you send me that deck. Yeah, whatever we can do to reduce that friction because like going back and forth to my customers seven times is rough. Yep. I’m.
Mira Guha (24:35) hoping that deck will help a lot and that is something where if there are any nuances based on what we’re seeing a lot for like provider type, Shannon could kind of help and be like, yeah, we should definitely like focus on getting these things up front. This one’s not so much going to matter but I’m hoping that deck will at least serve as a really good starting point. And then like we said, anything we can do via API to help with that completion is going to help a lot. But exciting to hear we’re going to have a lot of growth within the account. I know we’re just at time. I did want to just quickly make sure we had a chance to look at consumption because we’re seeing consumption pretty healthy. We’re trending a little bit high. This is from the last stack I sent over. So we’re just a little bit higher on consumption than where we are in the contract. Nothing needs to be done right now. This is really just going to be due to like the providers, the enrollments, the licenses, the monitoring, sorry, not the monitoring, those pieces that we’re doing for you. Some information about where the, I think this is actually from the last one. No, that’s from today. You can go into. I will show, you can monitor this in real time in your account. We have an interactive usage database here for your account. We’ll show all this information. You have skuflex. So can do with those dollars, whatever you would like. We’re really just tracking how much you have per year and how much we’re using in that year. You can spill into next year a little bit. But we will reach out as we get close to that 100 percent annual utilization at 120 percent. We need to do a contract addendum or at least revisit how we’re managing that spend trends in the consumption people over time, requests over time can be tracked. An actual kind of laundry list of what’s being consumed here can be filtered by duration by time period as well as like I want to see how many licenses we consumed in the last week. You can go ahead and check those. And then you can export any reports. And this is something we’ll revisit every time we meet to make sure we’re keeping an eye on. It might be just that we’re seeing an influx of licenses right now compared to what we’d expect later, but we just want to make sure we’re on top of it. And if you have any questions on consumption or contract stuff, I can help with that.
Matt Vail (26:42) Yeah. Can you clarify one thing? So if I submit a request for a payer contract and then we cancel it, what happens is that consumed or not consumed? Yeah. So.
Mira Guha (26:52) We consider consumption here contracts as on request. We actually give you a little bit more leeway that might change eventually. But if you request like an enrollment or credentialing file, whatever it is, we just use those terms. Credentialing is on request. So if you create anything in here that’s going to get consumed right away, if you create anything in here, you have a little leeway. Once we complete what’s called intake, which is our team does the review of the request, the provider information, the group information… and we put it into a workable status. I’ll send information, it’s a little confusing. So we can actually start working on the application that’s when we consider it consumed because our team has done work on it. I can send some language about how that works and what counts as a workable status. But basically means once our team’s done the initial audit, it’s consumed against your contract. If you stop it before that, it won’t be consumed. And if you’re ever curious if something was or not, that usage database will help you go ahead and find that request.
Matt Vail (27:54) Okay. I just want to make sure then for example, there are some that are like you need two providers in Nevada before you can continue. Like I do not want those canceled. And I’m not really sure what you guys do because I get a task, I reply to the task and say like great, I’ll attach the two providers as soon as we have them. I just want to make sure those are not getting canceled because we do want to pursue the contract. We just don’t have the two providers yet. Yeah, I can.
Mira Guha (28:20) Go ahead and take a, Shannon and I can take a look at what some of those requests look like. And we shouldn’t be stopping those. They might be like put on hold or pending dependencies, but they shouldn’t be stopped. So, I’ll make sure I check with her. And I can also let you know like, hey, this was consumed because we did the audit or like, hey, we haven’t it hasn’t been consumed yet.
Mira Guha (28:37) Perfect. I’m going to make a note to send this information just to help with clarity. As far as I know we’re over time. I’ll go ahead and also make sure we set up some time next month if we can find something recurring. I think that’d be great. And then I think meeting with Shannon will super help you out. This was great. I really appreciate you taking the time again. I’m sorry that it hasn’t been as smooth as we were hoping, but hopefully we will see that improvement over time, yeah.
Matt Vail (29:02) Totally. I’ll look out for your email and I really appreciate the help and excited to start getting more providers in there, absolutely same.
Mira Guha (29:10) Here. Well, thanks, matt. Let me know if you have any questions.
Matt Vail (29:13) I will do see ya.