Transcript
Samantha Bouchard (00:00) hey, Sam. Hey, hey, like the haircut Jake?
Jake Shubert (00:06) Thanks. Although I got random parts of my hair sticking up. I’m trying to get down before this call. I didn’t realize when you got a bad back. I’m not really walking to look at myself in the mirror. Oh, shit. What are we going to do?
Samantha Bouchard (00:20) You need one of those wax sticks handies?
Jake Shubert (00:23) Yeah, exactly. Well, whatever, Jamie will survive… how’s Austin going? It’s.
Samantha Bouchard (00:32) good. It’s actually been really nice. We definitely missed you. Everyone’s like, where’s Jake? I’m like Aaron is back… but no, I like these ones. It’s so nice, like it’s just like quiet like we just had a team dinner last night, but it was just like me, mal Haas and Scott and then Zach Jarvis from like he’s our new head of design. He like joined us. Oh, that’s cool. We went to like a really cool like cantina Mexican taco place, do?
Jake Shubert (01:00) You know what the name was?
Samantha Bouchard (01:01) Oh, yeah. I used to live here, right? De, Nada, cantina. Okay?
Jake Shubert (01:07) I think I’ve been there but I don’t remember, but I’m pretty sure. Yeah.
Samantha Bouchard (01:11) Oh, it was good. I got so much food because everything was so cheap. Yeah.
Jake Shubert (01:16) You’re not paying for it, so.
Samantha Bouchard (01:18) Exactly like, I couldn’t believe it. It was like I got like four tacos, and then they have like these like the Mexico City quesadillas, it almost looks like an empanada, So, good, damn. But yeah, it was really nice. But, yeah, qsrs are going good. That’s good. Some people are getting hammered on PG, you know, the usual.
Jake Shubert (01:42) The usual, that’s usually me almost every quarter. I feel like I’m like destroyed… at qsrs. So, I have to, well, you saw the invite. I have to get my virtual qsr on Friday. I’m not worried about this one. It’ll be fine, but, yeah.
Samantha Bouchard (01:56) It’ll be on Friday for me. I know. I’m bummed, I have another meeting that’s overlapped, but, oh,
Jake Shubert (02:00) really in like the,
Samantha Bouchard (02:01) last like 15 minutes.
Jake Shubert (02:02) That’ll be totally fine. I just, I’ll you know, I’ll vaguely point to like our fastmed and soar, questions, but I’ll leave it to, I’ll just allude that like we will have crossclab stuff come up. Yeah. So, yeah… but, yeah, Nicole’s not going to be on this one today. Do, you know, is Hastin still going to join this call?
Samantha Bouchard (02:20) I didn’t see him down there, so I assumed he went up. So cool. Yeah, yeah, just make sure you introduce him, yeah.
Jake Shubert (02:27) I’m just going to say he’s like the head of our SC team, extra layer of support like.
Samantha Bouchard (02:31) That’s yeah, just say like, you know, he’s really led a lot of our, enterprise deals. And so we just wanted to kind of pull him in as an additional layer. So, cool. Cool. All.
Jake Shubert (02:42) Right. Well, Jamie is joining the room now. Should I let him in get started or should I give another minute for Hastin? Yeah.
Samantha Bouchard (02:49) Let’s give Hastin another minute. Okay, cool.
Jake Shubert (02:52) Well, I’m at least happy Jamie’s going to be here. Yeah. Do you know what other people like other teams went to dinner? I know Nicole’s team went to laundrette, which was a restaurant I’d been to before, it’s very good. But, did anyone do like a barbecue restaurant? Like, yeah.
Samantha Bouchard (03:09) Some people went to the Joe Rogan, comedy show and I guess, Shane Gillis showed up there. Got it. He lives here. I’m actually seeing him in, Boston, he like sold out like TD garden, which is like, oh, wow, where the bruins and like everybody play. Yeah. So it was, so I was like, oh, maybe he was practicing. I guess he was practicing for some roast of like kebab. Yeah.
Jake Shubert (03:35) I was wondering if like they went to, I’m gonna let Jamie in, but I was wondering if they went to like Terry black’s barbecue or like law barbecue there’s. Just a bunch of those places that I thought some teams might go to. Hey, Jamie, how’s it going? How are you doing pretty good. Pretty good. How’s your week been?
Jamie (03:53) I’m doing all right?
Jake Shubert (03:54) Glad to hear it. I’m I don’t know if you, what part of that conversation you just heard, but I’m trying to get the scoop from Sam. We have like a team off site in Austin, Texas right now that I was gonna go to. But on Sunday, I messed my back up for the first time in my life, which is, I mean, on the scale of back injuries, I’m probably pretty lucky but definitely not fun. But anyway, I wasn’t able to fly to Austin because being in a plane sounded miserable and sitting and walking and stuff isn’t the best right now, but I’m trying to understand where everyone went to like their team dinners in Austin, but it seems like no one picked a barbecue restaurant.
Samantha Bouchard (04:32) I think somebody might have there’s a Michelin star barbecue place that some people are gonna go to tonight, that wasn’t open Monday and Tuesday.
Jake Shubert (04:40) Interesting.
Samantha Bouchard (04:41) Austin has.
Jamie (04:41) Some good food. And then there’s something called black well, Lockhart Texas, just right outside of Austin. Yeah, is truly the capital of barbecue in Texas.
Jake Shubert (04:51) Lockhart is incredible. I Jamie, I don’t know if did we talk about this last time a few weeks ago? I lived in Austin for like four or five years and, I like once a year, I would make the drive to not that bad of a drive, but I would make the drive to Lockhart and just like eat so much and then pretty much just like get home and pass out from having so much barbecue food. Like Lockhart is incredible. Yeah.
Jamie (05:13) I think I’ve done the tour. It’s an, I always pronounce a couple of them wrong, but I think there’s black’s not Terry black’s.
Jake Shubert (05:19) but black’s yeah, just black’s yep, is.
Jamie (05:21) It kreutz or kreutz whatever. Yeah, there’s a couple there that if you do the tour, it’s like, yeah, and then don’t get me wrong, I mean, there’s some good in.
Jamie (05:30) Well, Austin has a lot of things that, but if you’ve lived in Austin, you probably know it’s a food truck. It’s a, it’s.
Jake Shubert (05:36) a hole in the wall over.
Jamie (05:37) Here, it’s some weird place and it’s just unbelievable. And then what’s the best thing out of some of the best barbecue I’ve ever had in my life was the salt lick, which is, I guess going towards the lake?
Jake Shubert (05:49) Yeah.
Jamie (05:50) There’s some amazing Austin, you could. Yeah, Austin, you can get very fat that’s.
Jake Shubert (05:54) for sure. Oh,
Samantha Bouchard (05:55) I must have to, before I go to my Uber, I might have to pit stop at some barbecue place and put it through the security and eat it. It.
Jake Shubert (06:03) Really is worth it. I mean, like,
Samantha Bouchard (06:05) because I can’t leave without getting barbecue like we got Mexican last night, but I’m like that would just be sad.
Jake Shubert (06:11) Yeah, the Mexican food is great too, but the barbecue in Texas is just different, like it’s so good. The.
Samantha Bouchard (06:19) Welcome party on Monday. We saw the bat thing, oh.
Jake Shubert (06:22) Yeah. The bat bridge, yes.
Samantha Bouchard (06:24) I was like, this is a tourist attraction. I had absolutely no idea. Like there were so many people on canoes and kayaks and boats under there.
Jamie (06:34) Well, Austin is, where are you from, Samantha? Where?
Samantha Bouchard (06:37) Do you live? I’m from south of Boston, mass. Okay?
Jamie (06:40) So, yeah, this may appeal or not. So we have in Nashua, we have something called they’re not hippies, they’re hipsters, right? Yeah, I don’t know. What do you call it? It’s very… I mean, like it’s a kind of a hippie, slash.
Samantha Bouchard (06:57) Yeah. We have some of those in like cambridge by harvard and stuff. So.
Jamie (07:02) I think Austin is kind of, but Austin, as they consider it kind of, it’s a very weird, I’ll say liberal open. It’s so different than I don’t want to say so different, but it’s a pocket that exists within the more I’ll say more conservative Texas. Yep. And it’s a, very unique culture for sure. Yeah.
Jake Shubert (07:21) When I lived in Austin, it almost felt like living. I know this makes no sense. But it almost felt like living in a landlocked island. Like you felt so distinctly different than like the entire surrounding area of Texas. It’s like there’s no water right now, but I feel like I’m on an island like it’s a pretty unique situation. Yes.
Jamie (07:39) They’re not wearing tie dye everywhere in.
Jake Shubert (07:41) Texas? No, no, that’s for sure.
Samantha Bouchard (07:44) Lots of tattoos, lots of tattoos.
Jake Shubert (07:50) Yeah. Well, cool. James, we can jump in and get started. I think it’s just going to be us for today’s. Call. Is that right? Correct? Okay. Awesome. Well, we’ve got an hour set up for today’s. Conversation. Does the full hour still work for you?
Jamie (08:04) Sure. Okay, cool.
Jake Shubert (08:05) And I did want to just make just one enter this one new face from the medallion side on the call today. This is Hassan. He leads our SC team over here, okay? And we wanted to bring him in as an extra layer of support and we always bring him in some of the larger enterprise organizations that we work with.
Jake Shubert (08:20) So I wanted to make sure Hassan was a part of today’s call. And Hassan, I’ll let you introduce yourself… yep. Thank.
Hassan Zahir (08:26) you very much. Jake and Jamie, forgive me if my internet is spotty like they mentioned, we’re at qsrs and the internet and the hotel isn’t the greatest, but my name is Hassan Zahir, I lead the solutions consultant team here at medallion. Sam is on the solutions consultant team. And so I’m just here in support of the opportunity, if there’s any value that I can add. But thank you for allowing me to join.
Jamie (08:48) Yeah. Nice to meet, you as well. Well.
Jake Shubert (08:51) Jamie, let me share my screen here real quick and kind of walk through like what our plan was for today and definitely would like your feedback to see if it sounds good to you.
Jake Shubert (08:59) We talked about this when we met a few weeks ago, but I want to make sure this is still sort of what you think would be the most beneficial use of your time. So we wanted to take the first 20 or so minutes on today’s. Call and talk directly about delegation and how we help expedite and support that process. When we chatted a few weeks ago. I know delegation was like really important to you and top of mind. So we wanted to make sure we, you know, expounded on that a little bit more today. And then from there, for the other half of today’s, call, we want to make sure we really understood your current processes on like a deeper level that way, you know, on the next call or future conversations, we can sort of reflect back to you what this would all look like if it was underneath one platform. So across, you know, Azura, the nephrology side, et cetera. You know, and including like provider onboarding, your non delegated enrollments, credentialing, privileging, hospital applications, so on and so forth. You know, all that work that’s being manually done today. To be honest, like I don’t think we’re going to be able to do all the process mapping for all those workflows on today’s, call. So we’ll probably just start off and go through like the provider onboarding process and then some of those enrollment pieces. And then hopefully we can tackle the rest if you think it’s worthwhile on a future conversation. And then to end the call, obviously, we can talk about next steps if, you know, are interested in continuing this conversation or if you prefer to sort of part ways as friends. But that’s kind of the idea we had for today’s. Call, does that still work for you? Yes. Okay, cool. And just to make sure like you think the process mapping, I know we talked about this last time but that’d still be beneficial for you to make sure like we’re really understanding fresenius’ current workflows? Yeah, I.
Jamie (10:35) Mean, I think at a macro level, yes, I think it’ll be helpful because I mean, like anything else if we’re going to change and although I think we’re still using, I think we’re using you all for some internal checks, correct? Yes.
Jake Shubert (10:49) Right? So.
Jamie (10:50) I think there’s already a relationship there, but if we’re going to use your solutions a little bit more broadly, I think having some understanding of what we’re currently doing and how that could be enhanced or improved upon or fundamentally supported in a different way, I think that’s a huge help to have us understand that.
Jake Shubert (11:08) Yep. We’re thinking about it the same way that’s perfect. And then since it has been a few weeks here, I did want to just sort of do this brief kind of like review slide to make sure Sam and myself we had everything accurate or, you know, nothing has changed over the last few weeks. So our understanding is there’s two different software tools in place today. You know, for Azura, you guys are using MD-Staff with that contract expiring around September of this year. And then the nephrology side of the business is using healthstream credentialstream. Yep, the ultimate goal here would be to have one single platform, you know, one single source of truth to share across those multiple service lines cause, you know, obviously that’d be an ideal process. But also today, communication across those different teams, you know, can break down a little bit and slow down timelines. You know, I think you shared on the last call like the example of like some information will be needed from the, you know, for the payer credentialing side of the house. But for privileging, there’s a separate team was interfacing with the doctors who’s getting all that information. And then that info isn’t necessarily flowing from the privileging team to the payer credentialing team. So making sure there was one single platform to sort of break down those walls. Yep, delegated agreements obviously, is a very large value driver, you know, first and foremost, getting turnaround times down to one day is obviously critical. But even beyond that, you guys are seeing 20 to 30 percent, you know, yearly churn in your physicians. And with those physicians sometimes taking, you know, about four months or so to get fully loaded into the system. It’s difficult when they take four months to load into the system and then they churn shortly thereafter. So getting delegated would make that overall process, you know, a lot more streamlined and efficient… when it comes to committees that’s a paper based process today, taking around a week or more internally. There’s a lot of folks spread across credentialing, recredentialing, government payers, privileging, caqh, et cetera. When we talked about it, we talked about like 24 or so full time employees who are managing that work in house today. And then you already called this out, but there is an existing relationship already between Azura and medallion which, you know, should make a lot of the internal politics and overall processes a lot easier here to hopefully be able to expand that relationship. So that is sort of the big picture summary here that’s still like ringing true to you. Anything changed since the last time we talked?
Jamie (13:28) No, I think all that makes sense. The only thing I probably would add on that, I mean you may have encompassed it with the 24 ftes but I think one of the other opportunities, how do we enhance? Not that it’s broken but our government enrollment capabilities. I mean we do it now. I mean there’s obviously one system that you go in and you work with medicare, but just to make sure that that’s managed as appropriately as possible, I think that would be another thing because it is right now a separate team and we’ve talked about potentially having that come over to my team. But if there’s you know, a more broad solution I think that needs to be understood in your value prop.
Jake Shubert (14:10) That makes sense. I mean, are there still those sort of like breakdowns and communications and handoffs with that specific government team as well? No, I mean.
Jamie (14:17) They’re pretty good and it’s taken some time. In other words, I’m not trying to throw them under the bus. I think they do an excellent job, but it’s like anything else, right? It’s not on purpose but if they’re working and enrolling, let’s say we have a new provider, right? We have to switch their government enrollment to one of our operating entities, you know, that’s a process that takes time. And then, you know, hopefully it doesn’t take too long. But if we don’t get that information more timely, that might delay us in moving forward on some of our payer credentialing activities. So just having it all if it was all sort of under one team, that probably would be less of a people stop calling me. It’d probably be sorry about that. It’d probably be more efficient. Yeah. And.
Jake Shubert (15:01) then also part of that.
Jamie (15:02) Team, we also share a little bit of updating the database. And so you can imagine like anything else, it’s standardization and making sure that, you know, making sure that we have some standardization across, that would be helpful. So anyway, just put that as that’s usually because we were, so, you know, we have medicare advantage and medicare is a huge payer for us. So to not call that out as a separate line item, if we’re going to develop a potential solution, just need to make sure that you’re you can talk to that. Yeah, that’s.
Jake Shubert (15:35) the exact purpose of a call like today to make sure we’re process mapping that. So that’s super helpful. And then one other question I had just quickly here when we’re looking at the two actual like software tools, you know, MD-Staff and credstream, how often is it that data needs to be communicated between those systems? Like what does that look like right now?
Jamie (15:55) I mean the healthstream side is a whole separate business unit. So they’re pretty much self contained, but, you know, from an MD-Staff perspective, right? In terms of, I mean they do have some forms loaded and you can sort of populate certain elements fields into the form, but it’s really, I would say not very helpful for us. So typically we have to pick up information out of MD-Staff and apply it to a separate credentialing application or a form online form. And in California, there’s a whole bunch of other things that we have to do. So it’s quite tedious. So there’s no talking but healthstream itself and MD-Staff, there’s not really any communication. Now. We would like to have the ability, you know, whether that’s API or other, to certainly have different forms that payers require to not have to do that step of manually taking that information and expediting that even if you can’t really connect to the payer, you know, directly. But just to create the forms and populate the fields that’s one function in MD-Staff right now, that continues to be I’ll say… 2004. Yeah. But honestly, yeah.
Jake Shubert (17:17) That makes sense. We’d.
Samantha Bouchard (17:18) definitely be able to upgrade that, Jamie, and then also take on the portals as well. So we have RPA technology that can log into the portals and kind of fill out that information. And we also are able to do like all of your medicare and medicare advantage requests sort of at the same time, what we do is we have a dependency on those downstream requests. So as soon as that main kind of medicare line goes through, we can instantly get started on the medicare advantage pieces. We’ll definitely show you that in the demo but we, you know, thanks for sharing some of that and I definitely think that we can lean in and wow you with some of the technology that we’ve built out when it comes to forms and portals and the overall enrollment process.
Jamie (18:08) Yeah, that’d be helpful. Yeah, thanks, Sam. Well, I’m going to.
Jake Shubert (18:11) Skip through this slide because I have this here just in case any new folks were on the call today and weren’t familiar with medallion. So let’s jump straight into delegation though. So I know your payers, Jamie are already interested in fresenius being delegated which is huge and really exciting. And obviously preparing for delegation yourself is like a very detailed process that’s really difficult and time consuming and laden with risks. So let’s spend 10 or so minutes here and talk about where medallion fits in with this equation… because this is something that organizations of your size are typically looking to us to help with. So first, I know you’re already familiar with the value props of delegation. So I won’t sort of outline those but just speaking about outcomes, while we can certainly help you guys pursue and execute on as many delegated agreements as you would like. There’s always going to be some part of the pie chart where some of your payers, you will still have non delegated enrollments for your more traditional credentialing process, obviously, your government payers for starters.
Jake Shubert (19:11) But I’m sure there’ll still be some commercial payers stragglers for you guys too. So on the top, right? What you can see are what your current turnaround times look like. So around 57 days or so. And then the bottom is what it would look like with us. So our nationwide average in all 50 states across 900 payers is 52 days for turnaround times while five days, you know, that’s not nothing. But when thinking about an organization of your size across all of your providers, five days would be a pretty significant revenue acceleration. You know, even talking about non delegated enrollments, but when we pair those five days with, you know, the additional efficiency gains of time savings with provider onboarding for privileging for your, you know, internal team handoffs, you know, right off the bat, we think that’s going to be a pretty exciting impact. But then what really drives things obviously is the delegation component where we would bring your turnaround times down to one day. So that’s really what we’re looking at here in terms of eventual outcomes?
Jamie (20:12) It’s the administrative hassle of chasing all that stuff, you know, as opposed to sending them a list versus sending it calling. Did you get it? Oh, got to resubmit it. There’s. The administrative cost savings that would be tremendous as well. Yeah, being actually the.
Jake Shubert (20:27) one in control of that credentialing process is obviously like huge and obviously, I think for everyone’s mental health having to deal with payers as little as possible is always the best thing there. So, yeah, that definitely attracts. But I sort of wanted to share this like big picture slide before we jump into the specifics of medallion. So I wanted to share here a little bit of like a, you know, for lack of a better term like a, you do we do and what you’re going to find. And I’ll summarize all the text in the slide. But what you’ll find is that we are trying to leave the strategic decisions for fresenius up to you guys. But take all the regulatory grunt work off of your plate. So this top section of the slide here is what you’re going to see are fresenius’ responsibilities. So here’s what those are, the first is going to be choosing which payers you want to be delegated with obviously, and then reaching out to your contacts with those payers to let them know that you want to be delegated. This is typically like the most important step for our clients. But since you guys already know your payers want you to be delegated, this should be really smooth for you guys, which is pretty awesome. Then the last piece at the top is since this is like a business and strategic decision for fresenius as a company, is that any negotiation on terms with the payers we leave up to you guys.
Jake Shubert (21:44) So you don’t necessarily have to negotiate. But if you do want to do, that would stay on your plate from there. At the bottom, we’re really taking care of the rest. So we have pre built policy and procedure templates that we can supply to you guys. So you don’t need to build those from scratch. We have best practices and guidance on committee, structuring committee, cadences your overall operations. Etc, we talked about this last time but since medallion is an ncqa certified cvo, what we will do is we’ll act as the sub delegate on all of your contracts with your payers, which means that fresenius you guys won’t need to prove your own ncqa certified process.
Jamie (22:25) So you read my mind. So are there payers in this world that say we’ll see medallion cvo and go? Okay, we have a relationship. It works. We don’t have to reinvent the wheel here. Is that what you’re saying? Basically, yeah.
Jake Shubert (22:40) Yes. Okay. Yeah, they.
Samantha Bouchard (22:42) All essentially will say that Jamie, because we’ll become your sub delegate, and then we withhold that ncqa accreditation.
Jake Shubert (22:51) Okay. So.
Jamie (22:52) In other words, when I negotiate something, they’ll appreciate that as opposed to we have our own, they’ll say, okay, yeah, it works. We’ve agreed to it in the past. We probably have, you can’t tell me the number, but is it a lot more than 10, less than a 1,000 in terms of where you’re a delegate for a particular group? Yeah, I mean,
Jake Shubert (23:13) it’s quite large. Jamie, we have over 400 customers. We’re delegated with, you know, having contracts with pretty much all the top payers in terms of supporting our customers having those delegated agreements. So, yeah, I mean, not to like, you know, be like cheesy, but like we’re the, you know, we’re the number one cvo in this space. So it’s a lot of like name brand recognition with the payers. Yeah, no, no.
Jamie (23:36) That’s I mean, that’s the whole thing, right? Yeah, they all want us to do it, but then it’s like the nuts and bolts and the actual process. And do we have all that stuff in place before they just say yes, right. Yeah. So if all that’s agreed, they have, if they understand that, then it goes, the value right there is tremendous.
Jake Shubert (23:52) Yeah. And yeah, you said it in like one sentence. What I just did for like five minutes. So I appreciate you being more concise there, but yeah, that’s the exact story here. And then even beyond sort of like that ncqa certified process with the payers, like all of the delegation audit support. So the pre delegation audit, you know, everything that is required there. We will support you on as well. So we’re handling that on your behalf. And then obviously, like once you have the delegated agreements, all the credentialing work gets done inside the platform. So let me.
Jamie (24:25) ask you more. This may be a slight political question. So we obviously are privileging people and we have, you know, governing boards that approve the credentialing credentials of folks that participate in each individual asc? So when we set this up, will each of the, I mean, will each of those organizations continue to have that governance structure or are you integrated into that process? We would?
Samantha Bouchard (24:52) Likely, you could utilize the governance structure that you have today, Jamie for these files. So like these are ncqa files and then likely the files that you’re using through your privileging is the joint commission. I think we confirmed that, right? That, that’s the standard you all are working towards. And so you could utilize that same committee structure or potentially set up something new for medallion. We do have, we have asynchronous voting available directly in our platform that really tracks all of the key like audit, you know, the notes, all of the information that, you know, if you were audited, we would be able to support that process directly. So when we get to a demo, we can definitely highlight those features and spend some more time kind of evaluating if, you know, using that current governance structure would make the most sense for fresenius?
Jamie (25:50) Jamie?
Hassan Zahir (25:50) What would be your preference there? Would your preference to be since you have a governance structure in place that you just maintain that or would you be open to seeing like just what the functionality is in medallion?
Jamie (26:04) Well, it’s a good question. I think if I’m just, you know, maybe I’m making it too simple. But if you’re preparing the files, right? You’re doing all the work so that a committee, let’s say the local operating entity level could then look at it and approve it. I still think those folks, whether it’s a medical director, whether whoever’s involved in that governance at that local site wants to have some control and approval of that. In my mind. That’s how I would see it working. But I just was curious if you’ve had that type of situation before where maybe you’re doing the heavy lifting and then there’s a committee of interested parties that are sort of reviewing that and approving it. Yeah. And.
Hassan Zahir (26:50) just so to be clear that’s exactly how it would work, medallion would perform the psvs, we would construct the packet. We would just build the committees in platform where those people could either log into the medallion platform and perform the approvals or they could do it in the way that they’re doing it today. They could kind of just meet in person and do it. So the short answer is how you’re thinking of it is how we can configure it.
Samantha Bouchard (27:15) Gotcha. Okay. Some.
Jamie (27:18) Of it’s politics, some of it’s just, yeah, functionality that’s how I would want to do it, log in and say, yes, no, but, you know, everybody has to be part of the puzzle here. Yeah, the.
Jake Shubert (27:30) Venn diagram of politics and functionality is always interesting to navigate. Also, Jamie, I know you’ve seen the medallion platform before, but just to offer it, like if you want to just do a very delegation specific demo, we can, we’re happy to do that like next week or whatever works best for you. Just to show you like when Hasan and Sam are talking about, you know, electronic committee voting and creating the credentialing packet, and all that kind of stuff. Like for you to actually have the visual of what that looks like in the platform. I.
Jamie (27:57) Do want to do that, but I also want to get… dr miller our chief operating officer. I’d want him to see this because, you know, when we first flipped over to MD-Staff, I know you’re recording me, I’m going to get in all sorts of trouble but I wanted to use to, I wanted to move to a faster or say faster a more… I’ll say a modern application sooner. And so, one of the things I think is going to be tremendous value if we do switch solutions here is this delegation. So I need to, I would want him to be part of that demo so he can see how this is all set up. It’s plug and play, yes, we pay for it, but it’s plug and play and it accelerates all the things we’re talking about. I’d want him to see that framework so that we can move on this faster. So I’ll get with him at potential times and Jamie.
Hassan Zahir (28:49) Just so that we make the most of that time, what do you think is the most important thing for him based upon your knowledge of how he is and how he thinks what would be the best thing for us to focus on that sort of demo?
Jamie (29:05) I think simplicity, right? In other words, we’ve talked about this gosh for years and we’ve talked about all the different teams, you know, with all the things that you mentioned in your first slide, I think for him is simplicity and,
Hassan Zahir (29:22) if we.
Jamie (29:23) Can essentially buy the structure, right? And it can be supported and it accelerates all the things we’re talking about. I think it’s simplicity, integration, simplicity. And can it, you know, I think if the payers recognize it, I think all of those talking points help, but I think he just wants to see how simple it is. And can, I think the other part he’ll want to say is, can our enterprise manage it in conjunction with you all effectively? I think that’s what he’s wanting to see how big of a lift it is for our organization to integrate it, right? Yeah… he wants no noise. I guess that would be his probably red flag is how much noise will this cause is the, what’s the word is the juice worth the squeeze, terrible metaphor, but, you know, return on investment, right? What’s the return on investment? Yeah.
Jake Shubert (30:20) And just speaking on that return on investment piece, like from both your lens, but also the CEO’S lens. Like when we think about return on investment, obviously, there’s the elimination of noise. You were just talking about. There’s the ability to support you and help the whole operation. But from a financial perspective, does dr miller care about like opex reduction on staff? Does he care about turnaround time acceleration? Like like what for yourself and for him? Like what are sort of the priorities in thinking about Roi?
Jamie (30:50) Yeah. So, he is a doctor, so he does care about money. I know you’re recording me and he would say the same thing. No, I think it’s all those things, right? Okay. There’s a tremendous amount of administrative hassle even when we bill and collect, and, you know, when doctors aren’t added and it messes with the scheduling. There’s so many different fa, are we, you know, are we Q sixing them properly? Can we do it? Are they subcontractors? It creates so much noise in our system when these folks are not added timely. And so, plus our system, because of the way that we engage physicians, we’re there’s some churn. So we see, you know, it’s not like a typical practice where there’s you know, 10, 15 people and then once every, you know, five years, we add one or two folks. We’re churning you.
Jake Shubert (31:35) Know, physicians who come.
Jamie (31:38) In and sign agreements. They may be, you know, working for us for a year or two. So, a lot of, there’s a lot of onboarding that goes on and it’s noisy and it puts strain on our organization. So, you know, I think he, the value he would see is obviously, if we can accelerate it, there’s dollars there, but the administrative complexities. Yeah. And quite honestly, he crates them because he’s hiring all these people. So if he could see a reduction of that, you know, that’s tremendous upside.
Jake Shubert (32:08) Yeah, that makes sense. And then also just, sorry, one more question that popped up while you’re talking about that, when thinking about like the turnaround time improvement, how much does like an average fresenius provider generate in revenue per day?
Jamie (32:26) An individual provider in net revenue? Yeah, somewhere between 20 and 30 grand per day? Yep. Okay. Cool.
Jake Shubert (32:34) That’s helpful. And also one other question just on the delegation piece. Do, do you guys have an npdb id already? No. Okay. Yeah, that, that’s totally fine. I want to bring that up because when we’re thinking about delegation, we like to be pretty since we do this so often, we like to be pretty consultative with our potential clients on sort of the front end steps that are going to accelerate the overall process. And the two things we would call out that are most helpful to do on the front end are contacting your payers and understanding if they want you to be delegated, which sounds like you’ve for the most part already done. But the second piece and we can send you instructions on this in a follow up email, but is getting an npdb id. That is a requirement for, being able to have delegated agreements. So, it’s pretty straightforward to do and Sam, Hasan feel free to add, any context here. But, that would be like an important first step for fresenius to, make sure downstream that we’re supporting you in delegation.
Jamie (33:38) Is that id for compliance? Sorry, is that id for compliance or just to connect to payers to transfer information or both?
Jake Shubert (33:45) It’s a primary.
Samantha Bouchard (33:46) Source verification, and where you’re doing the tjc files, Jamie, I wouldn’t be surprised if you actually do have one, but maybe that falls under like a different branch because that is, one of the primary source verifications that is part of that, overall packet, but it’s essentially the national provider data bank and it just checks for any, you know, claims or malpractice, and lots of other things on providers, just making sure they are who they say they are and don’t have any, negative things, on their, background checks and stuff.
Jake Shubert (34:21) So, I know we certainly.
Jamie (34:23) Checked that, but you’re saying, there’s a unique id for our entire enterprise, you.
Samantha Bouchard (34:28) Could have multiple, but, I would likely think that you all are, connected through them already for the joint commission. Oh.
Jamie (34:40) And I,
Jake Shubert (34:41) and I can send you the link just so you have it. Either way. I do think you probably already have one, but just wanted to flag it early in the process. So, it was under radar,
Jamie (34:50) Cool. Well, I’m gonna try to speed.
Jake Shubert (34:52) up a little bit, cause I realize I’m eating into a lot of Sam’s time, to process map, but, we’re, definitely making sure we’re covering important stuff here. So just, real quick, I just want to talk about this. So, this is sort of, what you’ll see once you do have a delegated or you do have delegated agreements plural in place, medallion, we are the only organization that actually contracts to, slas on our credentialing files. So, we have a three day SLA for our credentialing files. And our average is just one day, meaning that we will do all of the work to complete your primary source verifications, and get it ready for your committee electronically, in just one day. And then we’ll like we’ll show in a demo probably next week with our coo, you’ll see what that looks like in platform. But, we put our money where our mouth is here, and we have a three day SLA and one day average for credit files that’s.
Jamie (35:41) assuming you get everything from the provider, right? Yeah. So.
Samantha Bouchard (35:46) With our caqh import Jamie for an ncqa file, the requirements are less than the tjc that’s a little bit more intensive of a file. But with our caqh integration, we can pull in 100 percent of the data. We need to perform an ncqa file, for these providers. Yes, there’s always off chances that something isn’t up to date or there is something potentially, that is missing. But, you know, we do have a high success rate with that integration to really process those files. And in the average that Jake mentioned.
Hassan Zahir (36:22) And sorry, I won’t get off.
Jamie (36:23) track, but do you all update the caqh files as well?
Jake Shubert (36:26) We, we do, we have, we’re the only vendor that has like what’s called a direct partnership, with caqh like a participating organization status. So we actually do, bi directional caqh work. So, we do all the data pulling from caqh that Sam talked about, but we also make updates into caqh and manage the quarterly attestations too for your providers.
Hassan Zahir (36:46) Gotcha. Okay.
Jamie (36:47) Awesome. Thank you. Yeah, it sounded like.
Samantha Bouchard (36:49) you had one into one or two individuals, Jamie, that was solely responsible for the caqh updates. Is that accurate? It’s my team? Yeah. Is that a painful process for them or just, depends?
Jamie (37:05) On the physician, some physicians don’t even know, what it is? Some physicians never updated it. Some physicians, it’s their office manager who forgot their password. So we often have to go in there and update it.
Jake Shubert (37:19) it’s not the worst.
Jamie (37:20) Thing in the world, but sometimes we have to do it. And then it’s like anything else, it’s another element. The payers are more and more relying on. And so, if the, if it’s not updated, it impedes our progress.
Samantha Bouchard (37:31) Yep. That automatic rejection, and we are always, checking that too as our applications go out the door for payer enrollment, just ensuring parity with caqh, and doing those updates as well to, reduce any chance of rejection in that regard as well. So, we are very familiar and lots of, you know, other, you know, clients are, in the same boat as you, from that maintenance perspective.
Hassan Zahir (38:01) It’s all the doctors.
Jamie (38:03) The poor.
Samantha Bouchard (38:05) Doctors we put so much on them.
Jamie (38:07) No, no, it’s not fair. They have, they have no idea.
Jake Shubert (38:10) Yeah, save our.
Samantha Bouchard (38:10) life and do all this paperwork.
Jake Shubert (38:15) Although I would.
Jamie (38:16) Say, they do have interesting passwords for their caqh?
Jake Shubert (38:20) See, that, that’s the one part I don’t get to see. Yeah.
Hassan Zahir (38:24) Yeah, that, that’s.
Jake Shubert (38:25) hilarious. I will skip this slide cause we’re running a little bit behind schedule, but Jamie, I’ll send you a, like a PDF version of this deck so you can review it, but this is just a little bit more detail on the audit support that we provide, for delegated agreements. So, if you get a chance, feel free to read it over email or we can talk about it, on a future conversation. But just wanted to end here, with a little bit of like a, anonymized, customer reference story that we’ve done in terms of delegation. So, before we jump into process mapping, just thought, this could be relevant. This is an organization who kind of similar, to fresenius, where they were managing enrollments themselves in house with, like a software only tool that wasn’t really able to support them on their delegation journey, through working with medallion, they secured three delegated agreements in their first three months of, their partnership with us, and seven total with, national payers, in the first year, their first delegate agreement, came in place actually took, less than 30 days and it was with tricare. And then overall, like we’ve talked about, we took the delegated, we took their, enrollment timelines which were between 90 to 120 days depending on the payer, down to just one day through delegation. So, just thought this might be helpful, to sort of share as a little bit of a benchmark here. But, yeah, any thoughts or questions overall in sort of the delegation process and where medallion can fit in to aid fresenius?
Hassan Zahir (39:48) No, I like it. Cool. Makes.
Jake Shubert (39:51) sense. Yeah, awesome. Well, Sam, apologies on my side that I took so much time, on my part of the call, but, yeah, Jamie, we want to make sure we’re diving into the process mapping. So we better understand your workflows, like I said, we’re not gonna be able to get into everything today, but we’ll try to cover as much as we can. And then on future calls, we can do the demo with yourself and your coo, talk through some sort of value realization, and, you know, Roi, hypotheses, but also understand more process mapping for the other workflows. We don’t get to today.
Hassan Zahir (40:22) Awesome. Thanks.
Samantha Bouchard (40:23) Jake, can everybody see the lucidchart diagram?
Hassan Zahir (40:27) We.
Samantha Bouchard (40:28) can, cool. Thanks. Yeah, so, definitely want this to be conversational. Jamie. I tried to kind of outline your different areas, of the platform just based, like of your overall process today based on how we heard that from you, the different teams, you know, with pay your, provider credentialing, you have commercial, you have medicare advantage. So just kind of want to talk through all this kind of understand if you have any sense of timelines, like how the next event in a process potentially gets triggered. And, yeah, just kind of document all of that. So,
Hassan Zahir (41:05) We’ll start.
Samantha Bouchard (41:07) Here with provider onboarding. So you have a provider accepts the offer that goes through a data collection piece, can you talk me through a little bit about like what that looks like? And, if you have a sense of the average time it takes to collect all this information?
Hassan Zahir (41:27) So,
Jamie (41:28) The way I understand it?
Hassan Zahir (41:30) Is,
Jamie (41:31) so that you’re right? They accept an offer, there is, a, MD-Staff application that goes out, I believe it’s automated and.
Hassan Zahir (41:40) It collects.
Jamie (41:42) You know, critical information that we need to move forward, with the privileging, primary source verification. And then obviously, anything that we have a few items, that will go for, for the payer, credentialing. So, there’s an application, the application gets received, and then they move forward with their, we build a profile on MD-Staff. And then those, that information is used to set up, the files, for the privileging, committee. I think the interim step is there, I think they’re using UL to do some of that primary source verification checking.
Jamie (42:25) And then, and then, you know, obviously, there’s more broader onboarding stuff, everything from setting up, you know, their HR and their payments, and their GL accounts, and all that good stuff, but not really related to broad credentialing. Yeah, that makes sense.
Samantha Bouchard (42:41) And… the profile build, is that automated based on the application or is that then manually entered into MD-Staff?
Jamie (42:51) It’s a little bit of both. The application obviously fills in the information automatically, but then somebody has to scrub it, make sure there’s not any missing components. And then, they add additional information.
Samantha Bouchard (43:06) So, potentially, there’s some like back and forth happening at this phase that, like to collect anything that’s missing from the providers as well.
Jamie (43:16) Correct. So, typically, this is where you’ll see us ask questions like can we get your caqh profile password, right? You’ll hear you’ll, probably see things from our government enrollment folks. Can I get, you know, access to medicare platform? Do we have that password, et cetera, things like that, some of the basics that we need for the other teams, whether it’s government enrollment or our, my team, to move forward, and,
Jake Shubert (43:45) maybe, how often do the providers actually know their caqh username and password? Do they usually know it? Do they sometimes not know it?
Jamie (43:54) It’s gotten a little bit better in the past, but I would say it’s a 50 50 proposition. Okay? That makes sense. Our provider services have done a better job because we ask for it all the time and hound them. So now they’re pretty good about putting it on the application and not letting the application go unless we get it, but it’s still sometimes a challenge. Yeah. And.
Samantha Bouchard (44:17) Do you have a sense of how long this takes?
Jamie (44:22) How do you spell too long?
Samantha Bouchard (44:24) Like, best case and worst case, right? Sometimes you have those angel providers who do all their things.
Jamie (44:31) You know… so it depends what you mean by the thing. So, in other words, getting all the information in and then let’s say establishes established, are you talking about the government enrollment? In my mind, this thing should take, I mean, privileges whether it’s temporary or not, should take all of three four, five days. But in my mind, the government enrollment and this initial onboarding stuff, assuming they accept the offer. I mean, this whole process should not take more than 30 days. I would say somewhere between 15 and 30 days and like,
Jake Shubert (45:07) specifically on the onboarding piece. So, let’s say from when you guys first send out the MD-Staff application to when the profile on MD-Staff is complete. So, before the privileging begins and, you know, government pay or work begins just from MD-Staff application sent to profiles completed MD-Staff, like how long is that time frame on average?
Jamie (45:29) It’s about 30 45 days. Okay. Got it. That’s helpful. And no, I mean, if somebody were to hire me, right? And they said, you know, I could wait 45 days for sending all my stuff. I’d be like, no, okay. You get it the next day, but that’s just sort of the nature of the piece.
Jake Shubert (45:50) And do you have, do you guys ever experience any like provider attrition from them just getting frustrated with the onboarding taking a while and getting credential to take a while or is that not really an issue for fresenius.
Jamie (46:02) well, I mean, usually, it’s kind of a honeymoon phase. So they’re open for it, but do we have providers? I would say from our side, we have providers that are missing information. We just had a call this morning where we have somebody who wants to join our center, but they haven’t submitted certain stuff that we need. It’s been over almost a year.
Jake Shubert (46:20) So we have to hound them.
Jamie (46:22) We have to go to operations and hound them. Like is this real or not real? But I don’t think it’s so much from us. I think it’s more you’re hearing my internal idea of, is this process the most efficient? In other words, when I think of bringing somebody on board and signing them, I think there’s a level of urgency, yes, of sending out the application. Are we waiting five days to send an application or is it sort of connected to that? And are we chasing it down? So those key elements that are absolutely required are there so that the other teams and internally, we can move forward on this and how quickly in my mind some of the things out of medicare, I mean that should be a week, two weeks, things that are taking 30 days. Is that because we’re initiating it late? So some of that because there’s different teams, is that just because it’s different teams? Is it because lack of urgency? I don’t know if I have a line of sight other than looking at the macro dates because whenever somebody is a go live, let’s say in your blue box, I track that date. And so, because I’m always worried, okay, now, I’ve got at the end of the day, I have to have all those payer contracts linked. And so I want to know because I have to report back out. How long is that entire process taking? So often we see where the provider accepts and we’re doing our initial check that sometimes that’s taking a month and a half which in my mind is too long. Yeah, understood. Yeah. And what I’m also.
Samantha Bouchard (47:50) Hearing Jamie is that, you know, you’re collecting some of the information needed for privileging primary source verifications or likely, you know, trying to get all of that with the initial MD-Staff app, but then you’re getting some of the information for pay or cred. And so, I’m assuming when it gets down to here, when you’re in the medicare and the commercial teams, there’s essentially another need to collect provider information. Is that accurate?
Jamie (48:19) Yeah. So that’s exactly right. So, let’s say their caqh profile needs to be updated. But let’s say hospital privileges, do you have hospital privileges, some of our payers require that they have hospital privileges? So if that wasn’t collected on the front end, guess what we have to do, we have to call the doctor and figure it out. And then are they responsive, do they even know who the heck we are? Why are you bothering me those kind of things? So, yes, if there are specific payer requirements, you know, we have to do that. If there’s some type of I’ll.
Hassan Zahir (48:52) Say bad?
Jamie (48:53) Fact set for that particular doctor and there’s additional documentations required. We’ll go through physician services to get that too. That’s usually an exception, not the rule, but yeah, it’s those missing components, Samantha where if it wasn’t collected on the front end, we have to reach out and secure it.
Hassan Zahir (49:09) Got it. And physician.
Samantha Bouchard (49:10) Services. They’re doing the onboarding piece, correct?
Jamie (49:14) They’re doing the combination of onboarding and primary source verification, and then privileging. Okay?
Samantha Bouchard (49:25) Looks really messy. Jamie, I promise the next time you see it, it’s going to be very beautiful.
Jamie (49:30) It’s just.
Samantha Bouchard (49:34) like a brain dump here. And.
Jake Shubert (49:36) while Sam’s typing that Jamie, how large is the physician services team?
Jamie (49:47) I’d say seven eight folks. Okay. Cool.
Hassan Zahir (49:58) Awesome. Yeah. So.
Samantha Bouchard (49:59) One of the challenges. I mean, I’m just kind of seeing here from the gate is that, you know, you have all of these downstream requests that need to be managed, but you’re not necessarily like kicking them off out of the gate. And then therefore, there’s this need to kind of come back and add some additional information as the process is going through. But it sounds like privileging actually is every single provider going through the privileging process or does some skip like rate to payer enrollment?
Hassan Zahir (50:30) No, they all go through.
Samantha Bouchard (50:31) Privileging? They all do. Okay. And so, what’s the trigger that? So?
Jamie (50:38) It sounds like the provider?
Samantha Bouchard (50:39) Services team is kind of, you know, taking this MD-Staff application, building out the profile. It’s going rate to privileging, they’re kind of processing that in like the same space. But what’s the trigger that then triggers your, you know, commercial and medicare advantage teams to get.
Hassan Zahir (50:58) Started once the.
Jamie (51:01) Application hits MD-Staff.
Hassan Zahir (51:03) And so right now,
Jamie (51:05) it’s strangely enough, the trigger is a, unless we check, this is another thing unless we check MD-Staff every day, they say, oh, the application has been, the doctor has filled it out. What we wait for is we wait for an excel file that tells us, oh, these are all the applications that have just hit. So usually there’s like a week two week lag unless.
Hassan Zahir (51:26) we’re monitoring.
Jamie (51:26) It, so we don’t get like a system alert that says, oh, this particular profile has been updated which I’d love to have.
Hassan Zahir (51:33) So that we could start our.
Jamie (51:35) Process. So we’re sort of monitoring, but we’re really waiting for that excel file. If I’m totally honest to tell us, yeah, this application has been returned… move until we have the basic information in place.
Hassan Zahir (51:52) And this takes.
Samantha Bouchard (51:53) One to two weeks you mentioned.
Jamie (51:55) We can excel file. I think twice a month.
Hassan Zahir (52:01) So,
Samantha Bouchard (52:01) that sounds like a pretty big bottleneck there in it of itself.
Hassan Zahir (52:08) I’m gonna mark that. Yeah, no.
Jamie (52:09) No, I’m with you. The opportunity is if there’s a better front end capture better physician participation in providing critical elements, urgency and line of sight for multiple teams to act all at once. There’s some savings there for sure efficiencies.
Samantha Bouchard (52:27) For sure, definitely. And how are like the payer needs determined? Are you enrolling every provider? And like all payers in that particular?
Jamie (52:40) I don’t know if it’s patients coverage or something else. We don’t enroll them necessarily. But if they’re let’s say a new doctor, we do enroll them all over professional service agreements. So as you can imagine every payer may or may not have different requirements over a period of time. We have a sense of all that?
Jake Shubert (53:01) A difficult question to answer but is, since obviously, it probably determines by like, you know, region and coverage and stuff. Is there like a general average of like how many payers each provider is getting enrolled with?
Jamie (53:15) That’s the other challenge we have is because these folks have been staged renal disease. We don’t like folks to let’s say in my previous life where I was maybe orthopedics and other stuff where maybe we had 10 contracts. We like to be in network with just about everyone. And there’s a gazillion medicare advantage plans. So we probably enroll them in 15 to 20 plans on average.
Jake Shubert (53:36) Yeah. Okay. That definitely makes sense. Thank you. Sure.
Samantha Bouchard (53:46) So, at this point, they’re you know, enrolling in that coverage area, determining if there’s additional information, collecting more data from the providers. And then this is where we’re going into MD-Staff. Can you talk me through that process a little bit? Like you mentioned, some of the applications are pre confirmed, yeah.
Jamie (54:08) Once the application’s in there and we look at the information and assuming we have to, as you suggested, tweak or ask for additional information. Once all that’s complete, then we submit it to the payer in the appropriate mechanism that they require.
Hassan Zahir (54:23) And with that process Jamie?
Samantha Bouchard (54:25) Are they, so you have some of the form mappings built out? You said it’s a little bit subpar, then they’re downloading that information from the platform and like emailing it out of the system. Is it all tracked through MD-Staff?
Hassan Zahir (54:39) No, we track.
Jamie (54:40) All of this work through a separate application. So every linking of a provider’s provider, we track our own custom platform.
Hassan Zahir (54:51) And then any of the.
Jamie (54:53) critical items, we have a sort of a workflow area that we’re all that stuff is linked. So it’s as you can see, it’s sort of a we’re not leveraging the MD-Staff. We’re looking at the information and the documents are there. But often we have to extract all those elements and go through the, you know, the payer mechanisms. But we also have a separate workflow to track it. So we do not go, MD-Staff has some tracking ability inside their thing, but it’s like I said, it’s like Microsoft access jetsql. It’s so backwards and old, it just doesn’t work with our workflows the way that we want to and connecting certain things. So we don’t use their tools internally. We pull all that stuff out into our own.
Hassan Zahir (55:42) And Jamie, I’m sorry, Jamie, when you say you pull it out to your own, that’s all manually coming out, there’s no API or anything that’s one person moving data from one system to another that’s correct? Like.
Samantha Bouchard (55:56) that’s your source of truth, Jamie, this other system. So this is where you’re saying who’s par with what, who’s privileged, all of that data is stored in a separate system for like a billing.
Jamie (56:07) Yep.
Samantha Bouchard (56:17) Do you have a payer follow up perspective? Do you have a team dedicated to calling these payers? Getting these follow ups? How’s all that managed?
Jamie (56:26) Through the same platform. So we track obviously what it was submitted, any things?
Hassan Zahir (56:34) That we need to.
Jamie (56:35) Reprovide, reattest, blah, blah, blah, resupply, all that stuff is tracked. And then we have all sorts of messages.
Hassan Zahir (56:44) That comes out.
Jamie (56:45) To give us alerts. And then we have a regular meeting cadence where I credentialing manager will go over all that stuff and see where we have challenges.
Hassan Zahir (56:56) Like scenarios.
Samantha Bouchard (56:56) Where the team is like super bottlenecked and may not like kind of push on the provider, follow up. Like one common thing that we really see is like maybe somebody was par in a payer like two weeks prior, but that hadn’t really trickled down to the scheduling piece. And so, therefore, there was like two weeks or so or more where a provider could have seen a patient in that payer but weren’t able to.
Jamie (57:21) So, whenever we successfully link a physician or enroll them, make them part of a professional service agreement within 24 to 48 hours, we put them on the par grid, all of that is accessed live. So all that data is live. So we don’t have too much of a lag there. And then there’s alerts that go out when we update our database to the appropriate front desk people fas, to let them know.
Samantha Bouchard (57:54) Is the scheduling tool a separate tool?
Hassan Zahir (57:57) The scheduling tool is inside.
Jamie (57:59) Nextgen. Our patient accounting system.
Samantha Bouchard (58:13) Well, I guess last question for me and then I’ll hand it back to Jake is, are you able to kind of estimate the.
Jamie (58:22) amount of time?
Samantha Bouchard (58:23) It really takes to submit the enrollment applications?
Hassan Zahir (58:30) So, we.
Jamie (58:31) track this process just because I as chaotic as I just explained it to you which fundamentally it’s not broken. It’s just, I would say it’s not optimized. Yep we track everything from when we’re on a phone call and somebody says they’ve accepted the offer. All right, to when the applications return to an MD-Staff, to your point, when, okay, now that we have MD-Staff, the basics in there, when do we have enough information to submit it to the payer? And once we submit it to the payer, how long does it take before that payer’s fully participating and set up? So as I told you, we sort of look from the date from when the offer’s accepted, to when sort of that basic information, government enrollment stuff is up. It’s 30 to 45 days. So if all that’s good, then we should, once that’s all there, it should take us, you know, less than a week to submit it all to the payers. But sometimes when all that information’s not available, then it could be an extra, you know, two weeks, 30 days. But we’re averaging once all that stuff’s in there. I think we’re averaging somewhere around six to seven days work days.
Hassan Zahir (59:39) Before it gets submitted.
Jamie (59:41) To the payers and Jimmy quick question.
Hassan Zahir (59:44) Once it’s submitted to the payers, since this is primarily like medicare and medadvantage plans, are the providers able to start seeing patients at that day? Like are you able to backdate any claims to the day that it would submit it? Or do you have to wait for them to be fully at par? Yeah some payers.
Jamie (60:03) Will retro it to the date of the request or hire date, some payers do it prospectively, most do it to whenever they, if it requires a separate credentialing review, some payers just won’t even link the doctors, but usually it’s on the date of the request. So they’ll retro it back. And depending on our contracts, I mean, a lot of the new doctors we have are subcontractors. And so they can bill as long as they’re billing through the group id. Everything is copacetic. So it’s not as much of a risk. But then there are other payers where that’s absolutely, you know, we can’t do that until they are fully linked and approved. So it just depends on the payer.
Hassan Zahir (60:48) Is that mapped anywhere? I’m sorry, Jake, I know we’re cutting into the last minute. Is that mapped anywhere, Jamie, if you have that map, if you could send that over, that would be beneficial, not something we need to answer on today. We do have.
Jamie (61:01) Some insights of what those requirements are.
Hassan Zahir (61:08) And maybe we can ask further questions at another point. A lot of times, we like to compare our turnaround times with those payers where it’s required that you’re at par status just to see if we can also get you some benefit there.
Jamie (61:19) Yeah, no, I think we’ve been averaging. And again, it depends if you’re asking me in southern California to all the ipas that have two people doing it for, you know, 10,000 physicians, you know, that takes more than 50 days if you’re telling me about united healthcare.
Hassan Zahir (61:40) I lost you.
Hassan Zahir (61:48) Want to hear us?
Jamie (62:16) Cut out. Yeah.
Hassan Zahir (62:43) Normally, if it’s like internet, dropping his icon, would have dropped.
Jamie (62:48) By now. So it’s odd.
Jake Shubert (62:52) I wonder if he was like wearing a headset or something. Yeah, definitely possible. I can also give him a call on his cell phone too, just to check in. You want to try that, Jake? Sure. Let me give him a call.
Jamie (63:27) Jamie… on mute.
Jake Shubert (63:34) Oh, there you are. That was a, that was a mysterious zoom issue. Do you know what happened? I just.
Jamie (63:40) Dropped the mic. It takes us 50 days I’m out of here.
Jake Shubert (63:44) Literal literal mic drop you.
Jamie (63:46) All rolling your eyes that’s not very good. Sorry.
Jake Shubert (63:50) That’s that’s funny. Wow. What a, what a way to end the call. Well, Jamie, it’s at the hour mark. So, do want to be respectful of your time as far as next step to go, what would make the most sense to you? Should we set up the demo for delegation with yourself and dr miller?
Jamie (64:07) Yeah. I think that’s the, I mean, again all this stuff is you’re talking about different systems with so many different groups. I think the way for us to ultimately pursue this. Like I said, there’s a lot of things going on in the background, but I think the best way is just to use the delegation. And I mean, I’m selfish here because it affects my group the most, but I think we use the delegation and the value of that to sort of accelerate some of the other solutions that I think that would be beneficial to organization and managing some of the chaos that Samantha was trying to get her head wrapped around. I think that’s the next step. So if you don’t mind sharing some of this stuff with the deck, I’m going to use that as a precursor to say, hey, dr miller, you know, a lot of our tell a story. A lot of payers want us to do this delegated. I think this is the value we don’t want to reinvent the wheel. These folks are going to have to do it. Payers will be more agreeable to it. And by the way, we’re checking our primary source verification with these folks. Anyway, we’ve got a relationship. Why don’t we start this process now and do a lot of good things. And let me show you how easy it is in the demo and let’s get him some buy in before we start tackling some of the other folks in our organization.
Jake Shubert (65:21) That makes perfect sense to us. Do you have access to dr miller’s calendar?
Jamie (65:27) Nobody calls me all the time. We talk all the.
Jake Shubert (65:29) Time. Okay? I was just thinking if we want to set up like a placeholder time slot for, you know, end of next week or the week after or something along those lines.
Jamie (65:37) Let me get with Aaliyah and I will let me see what I can do.
Jake Shubert (65:42) Cool. And then Jamie just on our side for prepping for that call.
Jake Shubert (65:45) So we’ll obviously do the delegation demo. Do you want us to prep any sort of like, you know, slides in terms of like, you know, fte, potential savings in terms of a monetary perspective, or turnaround time, I.
Jamie (65:59) Think you put in one metric of the amount of time savings. I think that’s huge. But yeah, if there’s any savings in terms of admin hassle, right?
Jake Shubert (66:07) And then, you know, you may want to.
Jamie (66:09) Throw in something like, hey, if you were to hire consultants separately to get all this delegation in place to also be integrated with a system talk, you know, all that stuff, you know, throw out a number, don’t make it crazy. This would take you 5,000,000 dollars to set up. But if there’s some number in your mind that you think is reasonable, that would take to set this delegated credentialing up because we had hired some consultants before to sort of walk us through it. And it just became cost prohibitive without tied to a system. But, you know, think about that too. So it’s obviously administrative reduction and cost savings accelerating when these folks are par and the additional revenue. And then it’s like anything else, it’s what’s the cost of setting this up versus buying out of the box, right? What’s the savings there? Because this could be implemented tomorrow, potentially depending on my agreements I get with the payer but like you said, it could be done in 30 days if you are a partner. So I think focusing on the return on investment and I think that goes a long way to getting him to say, let’s explore this more well.
Jake Shubert (67:13) That sounds great. And Jamie also like, you know, obviously you’ll chat with dr miller’s scheduling and stuff. But if you want to have any call between now and then where we can chat more for things or even do like a little bit dry run of how we’re thinking about return on investment, we’re happy to do that. So we have that sort of fleshed out before we show dr miller. If that’s helpful at all from your perspective?
Jamie (67:33) I’m happy to make sure we have all the talking points in order that’s what I do for a living, happy to do it.
Jake Shubert (67:37) Yeah. Would you be willing to maybe just set up sort of that just like a minute, connect and dry on for dr miller. Maybe next Friday, would that work for you?
Jamie (67:47) Yes, schedule it and let me see what, my calendars but schedule it just Friday like at one o’clock or something cool.
Jake Shubert (67:55) Yeah. Like, okay, I can one Central Time, something like that. Yeah.
Jamie (67:57) That’s perfect.
Jake Shubert (67:58) Okay, sweet. So we’ll do that and then just let us know about dr miller’s availability and we’ll set up the demo call from there. And then I’ll send over the slide deck and then some npdb info as well as a follow up.
Jamie (68:08) Awesome. Thanks.
Jake Shubert (68:10) Y’all, well, Jamie, thanks so much for the time. Thank you for the mic drop as well. That honestly made my day and we will, we’ll chat next week. All right?
Jamie (68:19) Thanks, y’all, bye bye, Jamie.