Transcript
Samantha Bouchard (00:00) hello? How’s it going?
Vaughn Crapser (00:03) It is good.
Samantha Bouchard (00:05) Yeah, my first jabberbox wouldn’t let me in, but I got another one. So now I’m going to call them to refund me.
Vaughn Crapser (00:17) Did you have to pay again? First? Jabberbox wouldn’t let her in.
Samantha Bouchard (00:21) It’s tragic. There was like a tech issue. I’m like wouldn’t even let me enter an access code. It’s pretty.
Vaughn Crapser (00:30) Sweet that they have those though. Yeah, that was a thing it is.
Samantha Bouchard (00:33) Really sweet. And there’s WI fi in here. Yeah, there’s WI fi in here. It’s cozy. I do have my suitcase right next to me. Yeah.
Vaughn Crapser (00:44) Do you get it for a set amount of?
Samantha Bouchard (00:46) Time there’s a plug? Yeah, you can like pay for it. Yeah.
Samantha Bouchard (00:58) My phone got delayed very late, so.
Vaughn Crapser (01:02) That’s fine. Oh, that’s a bummer. Is that Ken? I don’t know, should I answer it? Well, you’ve called her before? Yeah, hello?
Vaughn Crapser (01:16) Hello. I’m now getting him on a list because I’m like, I know, I always try not to answer. But of course, right at this time, someone calls and I’m like, is it, Ken? Yeah. Yep. Just been… I’m just looking at barbecue to order. So, yeah, I’m on the side.
Samantha Bouchard (01:42) I will say the selections in this airport for food are actually like pretty good.
Vaughn Crapser (01:48) I thought that too. I didn’t even notice on a plate because it was just like get off the plane. I got in around lunchtime.
Samantha Bouchard (01:57) I didn’t notice either until right now.
Vaughn Crapser (01:58) Are you going to pick up something for the flight? Yeah… just eat a full.
Samantha Bouchard (02:03) I’m going to have time to have like a full blown like sit down dinner here by myself after.
Vaughn Crapser (02:08) This, I love that full meal, full spread on the flight that’d be great. Eating some ribs. If someone on my flight at seven a M tomorrow is eating ribs, I will be judging them though. I’ll be like chill.
Vaughn Crapser (02:37) Hey, Hassan.
Hassan Zahir (02:40) How’s it going Vaughn?
Vaughn Crapser (02:42) Oh, it’s good. Hassan. I’m impressed you went back to your room because I was like, I can’t or I’m going to fall asleep?
Hassan Zahir (02:48) So, I went and grabbed food with garrison and Cameron and then came back to the room. So, it was easy to do.
Vaughn Crapser (02:57) Okay. That’s still, I would have fallen asleep after food and then coming back to the room.
Hassan Zahir (03:03) And I ate a pound of brisket, I shouldn’t have said that like on a recorded call?
Kimberly Carriere (03:10) I can see.
Vaughn Crapser (03:11) The Gong.
Hassan Zahir (03:13) Notes right now.
Vaughn Crapser (03:14) Yeah, that’s an aggressive choice before a call, a pound of brisket all right, Kim’s, here.
Samantha Bouchard (03:21) It’s going to be summarized on the insights Hassan, right?
Vaughn Crapser (03:25) All right, Kim’s, here. Let her in.
Vaughn Crapser (03:34) You’re going? I don’t know.
Kimberly Carriere (03:40) Hi, good afternoon.
Vaughn Crapser (03:43) How are you?
Kimberly Carriere (03:44) Good. And you?
Vaughn Crapser (03:45) Good. We’re good. We were just talking about food decisions and maybe mistakes that we made.
Kimberly Carriere (03:51) Well, that is important food.
Vaughn Crapser (03:52) Decisions, yes, we’re currently in Austin, Texas. So some people have consumed a lot of brisket before this call. I was going to say, I’m sure.
Kimberly Carriere (04:01) There’s probably some barbecues a little bit in there, yeah.
Vaughn Crapser (04:06) Exactly. But it’s all good. We’ll make it through. Appreciate you taking the time to join. Excited to chat again. I think it’s been like a month, yeah.
Kimberly Carriere (04:17) Well, we’ve had a lot going on. Sorry, I apologize for that.
Vaughn Crapser (04:20) I know. I’m like, I don’t want to bother Kim because I think you had the board meeting.
Kimberly Carriere (04:24) We had the board meeting and then we had three major proposals back to back. Two of them are quite large, very large hospitals, hospital systems, I should say, and we’re waiting to hear back. One was supposed to give us the response today, and the other one, we’ve decided we’re going to do a consulting, long term consulting agreement with them until their other group ends, and then we’ll take that hospital, so.
Vaughn Crapser (04:50) Yeah, it’s been that’s good a.
Kimberly Carriere (04:52) Lot of negotiating a lot.
Vaughn Crapser (04:53) Of negotiating… you’re in the thick of that. Yeah, thick of negotiating.
Kimberly Carriere (04:58) And.
Vaughn Crapser (04:59) I saw it looked like Lisa started. So, I know you were busy onboarding her as well, right?
Kimberly Carriere (05:04) Yes, we have a new CFO that started. She’s well, this was her second week. So I got rid of finance. So go me, she’s got to take care of all that now. So that’s good.
Vaughn Crapser (05:15) Cool. Kim, with all of that new kind of negotiation with the hospital systems and kind of the new contracts, does this now also become a conversation that maybe is becoming more top of mind as you guys are expanding moving forward?
Kimberly Carriere (05:29) Yes, and that’s part of it. So, one of the facilities that, you know, right now in Memphis, I have, you know, more than seven MDS, and then I have crnas, so the two facilities, the one in Mississippi is a,
Vaughn Crapser (05:47) three?
Kimberly Carriere (05:49) No, sorry. One large hospital, three ambulatory centers, and the one I have up in New York that’s as large as Memphis. So, yeah, yeah. So that would be a lot of work, but we usually try to give ourselves 180 day runway. So the one in Mississippi, if that was to come through, which would be great, we would be able to retain some of their clinicians, which is great. The one in New York, we would not there’s restrictive covenants. So we’d have to start from scratch.
Vaughn Crapser (06:20) So how many new providers would that entail for you?
Kimberly Carriere (06:24) All well, up there, it’s probably a minimum of 50 MDS. And then I think it was like, well, I’m sorry, we took down the number because we put more crnas. So I think it was like 30 MDS and like something ridiculous like 45 or 50 crnas, something like that.
Vaughn Crapser (06:44) So it just changed the company’s workload a little bit. So.
Kimberly Carriere (06:47) It’s like, you know, all of our facilities except one are care team models. Everything is a care team model. So, you know, and every state has something different. So the hospitals have different, but then there’s different, you know, who requires Dea? Who doesn’t we’ve just found out one of our facilities in California is now trying to require… the crnas to independently have their own deas. Wow. So that’s like a whole other thing that we’re fighting. So, yeah. So we would, you know, right now we’re over, you know, we always use the number. We’re probably over a 1,000 clinicians. This would take us more to like, you know, you’re going, you know, high, really high numbers. Yeah, as well as corporate staff, you know, we’re already over 120, you know, you’re going to need people, you know, handling this account. So yeah, we’re talking big numbers and.
Vaughn Crapser (07:40) With the, I know you mentioned one of them, it might be a contract like agreement. Is that another one that you’re going to have to bring on new providers for, as well?
Kimberly Carriere (07:48) All of our new facilities, we have to bring on new providers. Okay? Unless we have providers that want to transfer, but most of them don’t so yeah, it’s always either a, see what we can retain or B if they have a restrictive covenant and we can’t retain them depending on the area of the country, we have to bring on new providers and locums.
Vaughn Crapser (08:07) Yeah, of course, locums, that’s a lot of exciting but seemingly a lot more work on your plate update. Yes. And hopefully some of the stuff that we’re going to talk about today, it sounds like it’ll be directly in line with easing some of the workflow for your team and making this a much smoother process. But we’d love to maybe before Yvonne takes it over, turn it over to you and hear how the board meeting went. Is there anything else that came up away from like the state of the business changing or priorities that would be important for this conversation?
Kimberly Carriere (08:37) No, I think, you know, it all went well. I mean, I think right now, the only other thing that we are looking at doing is I don’t know if you guys know about idr which is independent dispute resolution. So we’re looking at that from a revenue generator and, you know, potentially maybe down the road purchasing okay practices. So there’s a lot of still small independent anesthesia practices. So we have not done that. We’ve never dipped our toe in the water to that… especially being privately held, but we think that might be an opportunity for us. So, yeah, that’ll be the next thing is, you know, we’re creating a due diligence team to do that. So that’s probably the only new thing.
Vaughn Crapser (09:18) That’s really cool. And then in any of the conversations was any evaluation around in terms of what you’re evaluating maybe for the business moving forward brought up at all? We?
Kimberly Carriere (09:28) Have some. Yeah, there were some, I think, you know, a lot of different things we are looking at. There was also some diversification of our business that we were talking about as well. But, you know, more Ed, things like that, you know, because a lot of anesthesiologists now actually a lot of Ed doctors can give sedation so that’s a whole different market there. And then also us doing training up nurses RNS, to give sedation, they call them nurse sedationists. So looking at that as well. So that’s going to be probably a project for 20 27.
Vaughn Crapser (10:04) Yeah. OK. Great. Well, I’ll pass it over to Vaughn, thank you so much for the updates and very exciting updates to hear too. No worries. Yeah, it seems like you guys are doing an incredible job winning new contracts, but I’m sure like when you think about growth, like there’s a lot of long standing relationships in anesthesia.
Vaughn Crapser (10:20) I read, I think an article about you all winning that methodist hospital in Memphis and how that was like a 30 plus year relationship.
Kimberly Carriere (10:29) Oh, yeah. We got, we got thrown into every newspaper in the world.
Vaughn Crapser (10:33) There was literally an article in.
Kimberly Carriere (10:34) the local Memphis paper about we had some bad press, bad press of those terrible people from New York, but yeah, no. So we, yeah, the incumbent group had been there more than 30 years. Yeah, it was a big change.
Vaughn Crapser (10:48) So, they had to insert a little a quote at the beginning like just telling everybody that, you know, they, their business was still going well and they’re able to service other hospitals because, yeah.
Kimberly Carriere (11:00) It’s funny though because they, we actually use them as locums. Oh, yeah, because they, when the change over happened… they lost business. So, so we, so they, we use them as locums that’s fine. Listen, it all worked out in the end, but yeah, but it was funny how we had to get approval from the hospital to use them because they were locums. So, I mean, it all works out in the internet as long as everybody’s business is doing well, but it’s just, it’s funny when you go down there and you’re talking to them and you’re like you guys were the incoming group. You were here. We came and now we’re using you again kind of odd. But, OK, yeah, that’s the way it works kind.
Vaughn Crapser (11:37) Of works. We’ll make it work. All right. Our goal today obviously is to go through delegated support. We’ll also talk a little bit just about direct payer enrollment. Yeah, because that will still be a factor, right? You’re not likely not going.
Kimberly Carriere (11:50) To have delegated agreements with.
Vaughn Crapser (11:52) Every payer, are you still good until five o’clock.
Kimberly Carriere (11:57) I am. And then I have to run, I have a board meeting. I’m at my daughter’s school. So, yes. OK.
Vaughn Crapser (12:03) All right. I will share my screen while I’m doing that. We do have a new joinee on the call, Hassan. I’ll let him say hello real quickly.
Hassan Zahir (12:12) Yep. Nice to meet you, Kim. I’m Hassan, I lead the solutions consultant team here at medallion. Sam is one of those amazing solutions consultants on my team. The only thing that I like more than brisket is helping, you know?
Kimberly Carriere (12:24) Organizations do.
Vaughn Crapser (12:26) Good.
Hassan Zahir (12:26) Provider operation expenses. So, really excited. My wife is a physical therapist. My brother is a physician. My sister in law is a physician. And so, I know just a lot of those pain points firsthand so, happy to be able to join the call today and to be a part of it. So, thank you for having me.
Kimberly Carriere (12:45) Well, thank you for being on. I appreciate it. It’s very nice to meet you.
Vaughn Crapser (12:48) Thank you Hassan. All right. I’ve shared my screen. Are you able to see it? Yep. All right. In terms of what we’re hoping to cover today, I am going to walk through a couple of slides just to lay the groundwork for the delegation process and what that support looks like and the role that medallion plays. But I want to pass it over to Sam pretty quickly just so you can see it in action. You know, as you said on our last call, like this does seem like the biggest challenge bang for your buck. And so I want to make sure that you kind of feel validated in the sense that you know, this can help you reduce your dependency on locums and reduce the likelihood of those situations that you had with bcps in Michigan where you’re not able to backdate and you’re left holding kind of a big financial impact there. And then at the end, if we have some time would love to chat a little bit about like if this is kind of if this does validate your thoughts about like how we can support, talk about how we typically set up a business case and just general evaluation path, and what that looks like for you. Ideally, how we can support you along that, see if we can come to a partnership. Does that work? Okay? All right. What we’ve heard just real quickly don’t want to spend too much time on this. I think at a very high level, you know, delays in provider readiness are obviously causing you to depend on locums, it’s causing you to not be able to having to do write offs. So for claims specifically, you can’t backdate with certain payers, right? You know, you do have a pretty significant team managing kind of all of the different parts of credentialing and enrollment and applications today. And it sounds like based on your growth, that team might have to grow, right? And you mentioned on your last call, it seems like maybe you think already that it should be a little bit smaller than it is. And so that’s just in terms of the support that medallion can provide. Obviously, we are, we’re automating a lot of this process. We’re speeding it up. I think the big thing that we want to focus on is just the outcomes that we’re actually driving. We are an outcomes focused solution. And you mentioned on the last call that, you know, in terms of the demo and the tech, like it didn’t feel too different than qgenda and what you see today. But the truth is that like maybe that’s a good thing. It’s not a big difference from what you’re seeing but the focus on outcomes and actually getting providers enrolled with payers is going to be the big difference maker with the medallion solution and the support that we’re able to provide. And so hopefully we can show that with the delegated piece today. But then from a business case standpoint, that’s a lot of what we focus on is what is the impact of us putting these slas in place, getting providers enrolled quickly, getting applications for… enrollments or credentialing packets turned around in a very fast timeframe? What’s the impact of that on your business? And then lastly, you mentioned the multi state piece, you know, it sounds like Tennessee and Mississippi is top of mind. I think there were a couple of other areas in the country where you maybe had providers practicing across state lines and so that’s definitely something that we can streamline and make easy for you when it comes to requesting and maintaining those licenses. Okay? I know you’re fairly familiar with delegation, right? You mentioned before, you had considered becoming a cvo, Okay? So as, you know, for the most part, what we tend to see is that and this is kind of what you see is credentialing enrollment for providers, takes 60 to 90 days, sometimes more if there are errors on applications or depending on payer turnaround timelines, a lot of it is left up to the payer. So obviously, with medallion, in general, with those direct payer enrollments, we’re cutting that down to 52 to 55 days is typically what we see. But then with delegated agreements, we’re seeing one day turnaround times for those credentialing files. And so obviously that’s reducing your risk when it comes to depending on those locums and the risk of claims not being backdated and losing revenue from that. Are you familiar with? I guess the overall process of securing a delegated agreement with a payer? Have you kind of had those discussions at all with your payer? We have, yeah. Okay. Yeah, you don’t have any in place, right? No.
Kimberly Carriere (17:10) No.
Vaughn Crapser (17:10) Okay. And so typically, for most groups that we work with, and I think a part of the consideration with going into delegated agreements with payers, right? Is that it doesn’t happen instantaneously. It’s not a flip that it’s not a switch that gets flipped. It’s something that happens over time. And so oftentimes without medallion, you are establishing that initial setup. So making sure you have the committees in place, making sure that you are completing the files correctly to the standards of the payers. And then the payers are going to ask you to submit those ncqa standard files to them for up to 12 months before they begin considering offering you delegated status. And then you have a period of time where you’re going through what’s essentially known as pre delegation where they might come to you and do an audit where they essentially pull random files and check that they are filled out to those ncqa standards and all of that before they begin to allow those… delegated enrollments. And so that can take 12 months plus in many cases which I’m sure you’re familiar with. And so for a lot of people and I think you saw this at somnia, it’s just, it’s really in many cases not worth the time investment to go down this path. And so, ideally, with medallion from day one, we will be your sub delegate. We are ncqa certified. We are already completing those files to ncqa standards. So you are eliminating a lot of this early timeline. And from day one, we’re going to be able to begin submitting files up to those ncqa standards for the payers with which you would hope to get delegated agreements. So cutting a lot out initially. And then we’ll talk a little bit on the back end about some of the support that we provide just in terms of maintaining the structure.
Samantha Bouchard (19:09) Yeah. Vaughn, I just had one question for Kim, when you explore this in the past, it sounds like you all have a lot going on. So I can understand why taking on becoming your own cvo would be quite the undertaking. But just curious as you explored that, was there any areas that really made you say, you know, kind of balance the importance of the delegation, but then also say like we can’t accomplish this right now.
Kimberly Carriere (19:38) I think it was because of the size of the team?
Samantha Bouchard (19:40) Were there any areas? Yeah?
Kimberly Carriere (19:43) I think it was the size of the team that we would actually need in order to really make sure that we, somebody who’s following this, making sure that we could do the delegated credentialing going through the process. We were already joint commission accredited for staffing. And at that point, it really, I hate to say it didn’t really do anything for us. So we gave up the joint commission sale. It wasn’t worth it. And at that point, it was like, do we really want to invest more in this or do we actually want to look at something else? So we actually created, we had other entities that we thought there was better to put our energy into that were honestly revenue generating and that’s what we did. So. And then we just kind of put this on the back burner that’s kind of what happened.
Samantha Bouchard (20:24) Got it. And then Vaughn, can you just go back a slide that’s so helpful? Ken. Thank you. I just want to like, so, you know, from this timeline, you know, as, you know, like getting set up with the delegation, you know, it takes time, right? If you want to do it on your own, you’re going to have to get that mcqa accreditation. If you work with somebody with like medallion, we already have that right? So that’s going to trim out a lot. But either way, it’s still, you know, following the policies and procedures for that particular payer, making sure that you’re completing the audit ready files, which I’m going to show you in the demo today, how you wouldn’t need to scale the team? Like which was one of your challenges. We’re going to be able to produce all of those packets for you in an audit ready fashion? But just wanted to pause here and see, you know, do you have any questions about you? You know, how this works with medallion versus kind of setting this up on your own?
Kimberly Carriere (21:19) Anything, no, I mean, I know, I mean right now, I mean, I have four people that do enrollment. So I have my enrollment team is separate and apart from my credentialing team. So my enrollment team falls under the RCM team. And then I have my credentialing team where I have six to, I think well, I think we’re like more like seven and a half people. It’s like ridiculous. We move somebody to do something else. So, but, you know, the idea is they really should go hand in hand and that’s where I think we sometimes do have a lack of communication when it comes to the enrollments and the credentialing and we have talked about putting everybody under one team, but, you know, my RCM team gets very excuse, the expression pissy about letting enrollment go. And then I have my credentialing team going well, like I don’t want to work for RCM. So we’ve just kind of left it even though it’s crazy. They both report to me. I just honestly, I’m not going to lie, Sam, I just got lazy and I was not going to deal with the fight at the time. So, you know, eventually though now that we’re going on to a new billing system, you know, that’s why I was intrigued to hear how you guys do it because, you know, we do need to find efficiencies in what we’re doing especially as we go through. And right now, I think, you know, the billing side, I’m moving to a new payer system, but excuse me, new billing system. But again, I still have four people doing enrollment and I’m bringing on several different facilities that four people can’t handle that. Nor can my credentialing team of seven and a half people handle all the credentialing. So that’s why, you know, we do need to, if we were going to do it, I would probably take both departments and do it. And then, you know, kind of figure out what we need to do from there. But that’s kind of what is going on and.
Hassan Zahir (23:07) since you’re switching systems today is to like right now, like since you’re switching your billing system is right now a good time. You think to also kind of consolidate those two teams?
Kimberly Carriere (23:18) Well, I need to get through the system changeover first. I have to be honest with you. So we had, we were prior to this back in 20 24, we had outsourced our billing at one point. Somnia, did have it in house, then it was outsourced to actually three. We moved to three different billing companies over the years. And then just recently back in 20 25, we brought it in house. The system we wanted to use was not available. We went to another system. They’ve been horrendous. And that’s why I’m moving them to another system. And actually I was not here. I was here for pieces of it but I didn’t take over the billing department. It was under the CFO, but I took it over maybe in mid 20 24. Hence why we’re moving billing systems. So I have to get that transition done just so you guys know we are, you know, we’re responsible for the revenue collections for each one of our facilities and there is a reconciliation process. So the more Ar I collect, it brings down the reconciliation because a lot of our, some of our contracts are cost plus some of them are not, some of them are risk. And if they’re at risk, I need to make sure I’m collecting that because the hospitals are paying for locums or they’re reimbursing us for management fees or whatever.
Kimberly Carriere (24:39) We needed to be more streamlined and efficient in our collection. So that’s going to be like the first tranche is making sure that’s done. We finally got the system somewhat set up and we moved our first PC over actually in the beginning of April. So I have a rollout all the way through 20 26 to early 20 27. So then would be the next tranche would be like, OK, when’s the next change. But remember, you know, things go awry when I’m starting a new facility. So, and if I start to with an 180 day signing, that kind of puts everything off. So that’s what we’re trying to figure out now. I just have to make sure I have resources and enough project management teams that we can keep things moving. That’s all.
Hassan Zahir (25:21) No, that makes all the sense. I appreciate you explaining that Kimberly. No worries.
Hassan Zahir (25:29) Sam. Anything else on this slide you wanted to touch on?
Samantha Bouchard (25:33) No, just wanted to make sure, you know, Kim was kind of clear like where we come in and I.
Kimberly Carriere (25:38) do have a question. If we were to test you guys out on an account… like that’s? My other question is that, you know… let’s say that, you know, the one from Mississippi comes through. Is it possible like if we were to, if we were to do a, could you go account by account? That’s?
Vaughn Crapser (26:01) A good question. I think what we can talk about Kim and that might be more of a like scoping conversation, right? Right. We always have the ability to kind of what we always say is like we could tier out your contract structure to do like a walk jog run kind of situation where like, hey, okay, today, this year, we start with the Mississippi like new team.
Vaughn Crapser (26:21) And then next year we would add on maybe one or two more and then get you like fully up and running by the time let’s say like year three comes. So that is not something that we’re like opposed to doing it’s. Just let’s go. We can kind of set a call together to kind of see what would that work entail? What would we be doing in year two? And like how would we map out this out successfully with all the rollouts you have?
Kimberly Carriere (26:45) Right. No, no, I’m totally understandable very similar to what we’re doing honestly with the RCM team, but.
Vaughn Crapser (26:52) Yeah. So we definitely have the ability, and once we can like prove our value and be that vendor of choice, we can start those like kind of conversations of how do we then build out a successful implementation for you too? Okay. Yeah. Okay. I want to make sure that we get to Sam. So I think in general, we kind of talk about like where… we’ll step in as I’m sure, you know, like kind of the goal is like, all right, identify your top payer targets where you think they would be working willing to work with you in a delegated fashion. You all reach out, obviously get those delegated terms added to your contracts. And then really from that standpoint, we are managing everything from policies to setting up the committees to… completing obviously all of the packets in a timely manner. And so ideally, Sam is going to show that today in the demo, what that looks like.
Samantha Bouchard (27:58) Yeah. And Kim, what this? Sorry, Yvonne, I was just going to say what this slide is really like if you want to look at this after just really breaks down exactly how we support you all in this process. So doing this on your own. You know, you are all getting the ncqa set up. You’re creating your own policies and procedures that are in it alignment with their requirements. We have all of that as your subdelegates. So everything in this green box, we’re kind of able to support you on which just allows the process to go much quicker. And then as Yvonne said, from like the audit setup and all of that like we’re going to actually process the files. We’re going to support you in any audits, that kind of that would come up. And so that’s really where we kind of outline kind of your responsibilities versus where, you know, medallion can really come in and support and help streamline this process awesome.
Vaughn Crapser (29:00) Thanks, Sam. And just to call out kind of some of the outcomes of course, like one day turnaround for payer enrollments, two to three days to onboard clinicians through the platform, this is and this is a specific use. A specific client that we were working with. They actually saw their first secure delegated agreement in three days which was with tricare, and then they were able to secure three delegated agreements in their first three months on the medallion platform and seven within the first year. And so ton of success. Obviously, you know, we have experience doing this with organizations all across the country like you all are. And so depending on which payers you would want to focus on initially, we likely have experience working with them in a delegated fashion. The other, of course, the other thing that like the other component of this is the peer enrollment, you know. And we’re able to cut down pretty significantly on that timeline. We have some updates coming out in the coming weeks that I’ll be able to share with you that we’re potentially in some cases, we’ll be able to cut down those timelines for just direct payer enrollments even further. So we’re really excited and confident in our ability to support there even if you don’t have delegated agreements in place with all of your payers. Makes sense? Yep. All right, Sam. I’m going to pass it to you then for the sake of time.
Samantha Bouchard (30:25) Yeah, thanks, Vaughn. Can you see my screen? Yes. Okay, awesome. Great. So… Kim, our last demo was about a month ago. We looked at kind of the onboarding process. We looked at licensing, we looked at that pre app and the hospital applications, which is, you know, a whole other area of your business. But today, we really want to focus on… enrollment as a whole and look at how medallion can streamline that payer enrollment process. And then additionally how delegation can kind of change the whole dynamic of your business and really pull those enrollment timelines much quicker which, you know, is going to give you that revenue predictability, get your providers in the hospitals faster and all around kind of improve the process, right? So if we think about it like a scale right now, you have 100 percent of your payers with direct, we want to start to bump up and kind of even the scale out, right? Eliminating as many direct payer enrollments as possible. And so what that looks like in our system today is we really look to you all to, you know, own the strategy and then we’re going to own the execution. So as a provider comes on board, you’re going to take them through the whole pre op process, they’re going to go through the hospital applications. And then in the meantime, you can also initiate this credentialing file process kind of right after that initial onboarding phase. And so what that looks like is you would come, your team would come here, they would select, you know, a provider for initial credentialing, they would go ahead, you can multi select as well. So if you’re you know, taking on a new group and you want to get a bunch of files through, you can go ahead. And what happens from there is that our team automatically connects with all of the 90 percent of the primary source verifications that are required for an ncqa accredited file. So what you can see here is like, you know, some of those instantaneous primary source verifications are coming back. We’re also going to surface that credential file to you here directly in the system. So your team can, sorry, I’m at the airport, Kim. So my internet’s a little bit slow, but we’re going to surface this all to you. So you can kind of page through that packet as needed. But ultimately, we are creating this… ncqa accredited file in the SLA of three days. But on average one day. So ultimately your team is going to have access to that packet. If there is anything flagged that needs to be reviewed, we’re going to surface that for you all. But essentially, once it goes, through your committee which you can use our platform for, we would help you set that up. It really needs to be, you know, like a medical director from your team, you’re probably familiar with this from when you used got your tjc accreditation, but we have all the documents to help with that. And essentially, we allow you to run through the files, know right away which file is clean, which file might need attention, and then they are able to approve those files directly in the platform which creates that audit trail and helps support, you know, the ncqa standards for the voting aspect. And once we have all of that through, we’re going to place all of those providers on your customized templates, which would be the roster requirements from each of your payer, make those available to you. And then you would go ahead and submit those rosters to your payers, they are going to backdate the date of par status to the date that your team approved that file in the system. So that’s really how you see that timeline decrease drastically and ultimately get your providers in par, much quicker. Pausing there, is this what you expected to see? Did any questions kind of out of the gate?
Kimberly Carriere (35:03) No, I guess the, I guess my question is that if I was using the system or what is your experience with people using the system? Like with regards to number of staff that I would need on my end in order just to maintain the files because that’s really the, that’s a big piece of the question here is that I’m looking for efficiencies where, and I’m not trying to be rude. I know it probably sounds terrible when it comes to like ftes, but, you know, my budget is quite large. So I’m looking for an efficiency and scale. So, if I was to have something like this and for instance, for enrollment, I have, you know, four people, you know, do I really need four people doing all this? You know what I mean? That’s what I’m looking for? Same thing with the credentialing piece, Sam, like I think it’s great. But like, do I really need seven and a half people? Can I just have, you know, three people managing the system that’s what I’m that’s a piece of it. So like, I don’t know what has happened with other companies that you’ve worked with. Have they been able to create an economy of scale and create a savings from it? That’s what I’m looking for?
Vaughn Crapser (36:10) Yeah, absolutely.
Kimberly Carriere (36:11) Von, do you want to touch on that? Yeah.
Vaughn Crapser (36:14) Absolutely. I mean, I think most organizations that we are working with and of course, you kind of have a change management in place, change management plan in place with how you either shift that those folks to different roles within the organizations or focuses. But, yeah, like typically, it’s one to two, maybe three depending on the number of providers ftes that you would need to manage the overall system.
Kimberly Carriere (36:37) Okay. And,
Vaughn Crapser (36:38) Kim, like being super clear, this is a lot of the reason most people come and use medallion.
Kimberly Carriere (36:43) Oh, listen, without question. Yeah, they’re looking to.
Vaughn Crapser (36:47) Reduce their opex costs, and that’s where we can once we go through also some of the scoping questions and understand the load the team is taking on. We can actually consult with you and say, hey, this is what we would actually recommend in terms of the number of ftes you would need to retain and that’s actually part of our whole business case process with you. Okay. Great.
Kimberly Carriere (37:08) Yeah.
Vaughn Crapser (37:09) And I guess too, like my other question, sorry… Sam, I was just going to say my other question with that, I know Sam mentioned and I think I mentioned on the slide like the one day turnaround and three day slas is… like, is that as important to you? Because I know like you mentioned on, I think our initial call, like a lot of this stuff is the cost of doing business, right? Whether it’s depending on locums or it’s the write offs. Like is the cost quicker turnaround times? I mean, is that really anything that moves the needle for you? Or is it, oh.
Kimberly Carriere (37:41) Absolutely, because that means I can drop claims quicker. So the thing is that the quicker I can get somebody enrolled and I drop those claims rather than waiting them being in process, you know, because they know that they’re in the middle of enrollment, those claims actually get processed and paid. So actually for me, the quicker I get them enrolled, the quicker I get a payment. So that’s kind of what I’m looking for. The other thing too is that, you know, when we’re doing the idr piece, we want people out of the idea is, you know, we want people out of network, right? So that we can go through you get your initial payment. And what have you, not every facility wants you to do idr, I mean, because it’s bad by the way it’s also like bad press for their facilities, like everybody should be in network. So what happens, is like, for instance, the reason why I bring it up is that our facility in Memphis, it took them so long to do the enrollments that we actually with our previous billing company, we’re suing them. Wow. So because they weren’t as obviously they weren’t on your system, so they weren’t efficient. But that was, and it was a big thing. And, you know, when you’re talking to the hospital, so we took risk, it’s a lot of risks to take. And that’s why the sooner someone is credentialed the quicker we can get paid, that we get the revenue. And that’s what we’re looking for. Okay?
Vaughn Crapser (39:06) The, I guess… and I’ve been thinking about like obviously revenue is important for the organization. I think it’s important for every organization, right? I’ve been thinking about like, what is the value of this to you all? From what I can understand from the outside, it’s like, you know, you have a reputation in the market of being a good place for anesthesiologists to work, a good partner to partner with for hospital systems or health systems. Like what else? I guess, does that revenue allow you to do that is a.
Kimberly Carriere (39:34) Oh, I mean, it allows me to take more risk. I mean, I can go into accounts now and take more risk and, you know, we’re in a market where anesthesia, you know, we’re fighting against northstar, we’re fighting against napa and some of the other big ones. We’re not private equity held. Everything we get is ours. So when you have something like that and a quicker turnaround, it allows you to go out to your potential clients and tell them that, you know, we’re going to be able to get you revenue because usually it’s a revenue share in the beginning. So, you know, when they come in, you know, and by the way, changing anesthesia groups just so you know, that either breaks or the administrators in a hospital that either makes or breaks their career and tell you right now, so like you change an anesthesia group because you’re messing around with, your surgeons either leave or they stay or they come back. So for us, it’s a big deal and they need, they also need that revenue pretty quickly for their facilities. So, I know we’re at time. This is what I am going to ask for. Can you guys send me three references?
Vaughn Crapser (40:43) Great question. So we will normally inside of our process, we’re doing reference calls once we’ve scoped it out to make sure that we’re setting you a reference.
Vaughn Crapser (40:51) That makes sense. So would it be a great like an acceptable next step for you? Me and von and Sam just to meet for 30 to 40 minutes, we’ll scope out what your business case is, which also helps us scope out like what you would need. And then we can also start this piece of like, hey here’s what you would be committing to be able to commit to from a reduction cost, a revenue acceleration cost, and what this actually brings.
Vaughn Crapser (41:16) And then based off of that and what we would are in terms of like what features and medallion we’re scoping in, we can then talk about the reference calls to make sure you’re talking to a customer. That makes sense. Sure.
Kimberly Carriere (41:28) Okay. So just say just reach out to Lori and get that set up. It’s probably not going to be, I have to be honest with you, it’s probably going to not be for like two weeks though. Okay. I’m going to be probably on a plane in the next two weeks. So, but I reach out to her and see what time you guys can get. That would be great. A.
Vaughn Crapser (41:42) Good plane ride.
Kimberly Carriere (41:43) Hopefully.
Vaughn Crapser (41:45) Hopefully somewhere nice fun. I.
Kimberly Carriere (41:49) Wish, but no, probably.
Vaughn Crapser (41:50) Memphis, so, with what you said about the hospital administrators, how this can make or break their career, is you, I assume your CEO is involved in those conversations too mark?
Kimberly Carriere (42:02) Yeah. No, the entire admin. I mean, we’re all in it, but, you know, it goes down to everything, Vaughn, it’s not just, you know, you’re changing the anesthesia group. You got project management in there, moving the clinicians, you know, you’re hiring clinicians and bringing them in, you’re doing your enrollment, but do you have the right clinicians, you have your surgeons complaining where, it’s a big deal for a hospital. I mean, some hospitals, it takes them six months just to sit and meet. And usually it’s you know, you’re when they’re going through the process, the RFP process. You know, you have three and it’s usually the largest ones. And the first thing they ask you is give me a list of all the anesthesiologists or crnas in your area that you’re going to hire. Yeah, that’s the first question. So it does, it makes or breaks their career. So like case in point mass general, we’re not there, but we have an account in Massachusetts. We’re looking at, we know that they are dying for crnas and MDS and it’s all over the internet pages. I mean, our pages, they can’t get people. So you have people leaving, which is a very prestigious hospital, mass general surgeons going to other hospitals because they can’t cover all the cases. Yeah, we wouldn’t even touch mass general. Massachusetts is a very tough state to recruit like, very tough and the locums cost they’re out of control. So we also, we’re very strategic in the areas that we will also go into like Michigan is a really tough state. I have to be honest with you and they tend to use a lot of. And actually, Sam, this is a question for you. We have, in one of our states. We are using certified… anesthesia assistants. Have you guys dealt with that into actually getting them credentialed because we have to, you know, we’ve one of our facilities. We had to change the bylaws but they have to go through credentialing and it’s a medical direction model but they have to be enrolled. Have you guys done that? Do you know? Yes.
Vaughn Crapser (44:02) That’s one of the provider types that we support. Okay?
Kimberly Carriere (44:06) And then you guys, I assume you guys also do other allied health like all nurses, and everybody else. Because one of the other, you know, one of the other avenues is that we are looking for. Well, we have two, we have two different why we have two different things. I was like scoping you guys out for one was our nurse sedation program and making sure, the nurse anesthetist or excuse me, the nurse sedationist can actually be credentialed that’s one because they would have a certificate to give sedation. So we would need them actually enrolled and credentialed at the facilities. The other one is we also use, we have a preferred vendor who’s actually our locums vendor… and so maybe actually utilizing them as well and helping us with that. So there’s kind of some other, you know, maybe going to the other question is that maybe for scoping purposes, but yeah.
Vaughn Crapser (45:03) That.
Kimberly Carriere (45:05) even though we’re not supposed to say anyone and say anything that locums vendor is like our, is our locums person. So, but we have to use them as a preferred provider. But yeah, so, but they’re actually utilizing some of our services internally so that’s a drain to our services as well. So that’s why I bring that up because that, you know, I was actually thinking of, you know, maybe you guys also could do something with them because right now we’re pulling resources to do that. So that’s why I was that’s why, honestly, I was also asking for the references to see if you guys had any locums ones that have used you guys as well because that would be, that would be a good one for us to talk to. We can.
Vaughn Crapser (45:44) Begin like, yeah, we’ll take that as a takeaway too. And then as once we do the scoping too, if we will align to make sure that we’re kind of like tackling what your need is versus the customer that we set you up with. Yeah.
Kimberly Carriere (45:56) That would be great. And.
Vaughn Crapser (45:58) I know you got to go. So I’ll let you go. But I was going to say the reason that I brought up mark, I know we’re working with other organizations like you all that are growing pretty rapidly and like for you like speed to par status is obviously, it’s kind of revenue critical, right? And so we see a lot of especially CEO led sales where they are leveraging medallion essentially in their sales pitch as far as like, hey.
Kimberly Carriere (46:20) We can, well, I mean, trust me if we, if this works, we’re going to, yeah, I’m not going to lie that’s exactly what we’re going to do. So if this works out, that would be part of it, is that listen, we would have a, we work, we would always say by the way we always disclose, we work with a third party vendor because we don’t want to sit and be disingenuous, but we work with a third party vendor. They’re doing our stuff, what have you, and then kind of go from there. But yeah, I mean, it also gets you to the table a lot quicker, you know, especially when you do an RFP and even an RFP, we would mention you in the RFP because that’s the right thing to do, but we would say that, you know, where you’re utilizing a third party medallion to do this. That. And the other thing you have to understand when you have a,
Vaughn Crapser (47:02) committee.
Kimberly Carriere (47:03) An RFP committee that’s looking at it, that’s a big deal that’s a big deal. So, yeah, and I don’t know, listen, I don’t know what other anesthesia groups you guys work with or whatever. But trust me, they’re all putting them in RFP. They’re putting you guys in every RFP. Yep.
Vaughn Crapser (47:17) Yep. That’s what we say. Yeah, that’s why I brought it up. I know, our executive team would be happy to connect with mark at some point when we get there. So maybe after the Eva. So if that’s a conversation that you feel like would be beneficial, we’re happy to coordinate that as well. No, I.
Kimberly Carriere (47:31) appreciate that. Yeah. So Vaughn, if you could just reach out to Lori, coordinate and then when we can, we’ll do the 20 or 30, you know, the 30 or 40 minutes and talk about, you know, scope and what? So we can kind of figure out, you know, what’s really needed but, that would be great. Okay?
Vaughn Crapser (47:45) I don’t want to keep you from your daughter, so we’ll let you go. Thank you so much, Kim. Thank you.
Kimberly Carriere (47:50) Guys.
Vaughn Crapser (47:50) We’ll talk soon.
Kimberly Carriere (47:51) Appreciate.
Vaughn Crapser (47:51) It.
Kimberly Carriere (47:52) bye. Bye bye, Kim.