Transcript
Peter Bosworth (00:00) hey, Peter. Hey, Amy. How’s it going? Good? How are.
Amy Frana (00:04) you?
Peter Bosworth (00:05) Well, thanks. Thanks for joining.
Amy Frana (00:10) Oh, yeah. You’re welcome. Sorry. I hadn’t realized that I hadn’t actually accepted until like last night when I was looking, I was like, no wonder he was reaching out.
Amanda Streeter (00:21) No.
Peter Bosworth (00:22) Sweat. Yeah. So I’m going to let Amanda in soon. I’m going to let her in, but yeah, we’re just going to kind of go through some of the, I think she’s going to want to get into some of the issues that.
Amy Frana (00:34) They’re seeing. Okay? And,
Peter Bosworth (00:35) I’m hoping we can just kind of like address those at a high level.
Amy Frana (00:39) Yeah, absolutely.
Peter Bosworth (00:41) Okay. I’m going to let Amanda in.
Peter Bosworth (01:00) Hi, Amanda. Hey.
Amanda Streeter (01:01) Peter. How are you?
Peter Bosworth (01:03) I’m well, thanks. How are you? Good. Thanks… great. Okay. So, I know there’s a lot we want to cover. So I’m going to quickly introduce Amy frana who is heads up our engagement management team and kind of is the manager of Shannon, but I’ll let Amy introduce herself really quickly.
Amy Frana (01:28) Yeah. Hi, Amanda. I can’t remember if we cross passed in one of Shannon’s meetings, but Amy, frana, as Peter mentioned, I’ve been here for about eight months now with medallion really partnering closely with Shannon on your account and our operations team working through the issues and excited to have a chance to connect and see how we can better support.
Amanda Streeter (01:52) Great. Yeah.
Peter Bosworth (01:55) So to make the best use of the time, like we have a quick overview of where enrollment stands today. And then there’s a list of seven or so payers that we’ve marked as having issues and then welcome kind of your input and context and feedback on those payers as well as anything else you’d like to discuss. Okay? So a quick snapshot as of today, so we have 512 enrollments completed in medallion 1,231 processing, three… 141 in needs client attention. And so, yeah, the general turnaround time from requested to completed is 50 days right now. And yeah, this is a good indicator of like your Nicole and the whole team, Colleen, rather being on top of the tasks in medallion. So we appreciate that. So any questions on this? No? Okay. So this is just a list of some of the payers that we’ve seen escalate with issues in recent weeks. Are there any kind of… obviously each of these has like their its own context, its own situation. Is there anything kind of specific you want to discuss with Amy today? Now that we have Amy on the call? Or where would you like to go here? Well?
Amanda Streeter (03:31) I guess tell me how you’re identifying these as the payers with issues?
Peter Bosworth (03:38) Well, I’m identifying these as payers with issues by talks with Shannon and her surfacing them to me. Okay? Yeah.
Amanda Streeter (03:50) So, I guess I would just say that my level of comfort is pretty low right now across all payers and I don’t know how to quantify it to, you know, a list of payers that I’m concerned about. I just know that we’ve had when we started this process, it was not on my radar that this transition would at all get a payer’s attention. And so the fact that two separate payer representatives have reached out because they’ve noticed a change in patterns and issues and enrollment for H ii is really concerning to me. And to be honest with you, I don’t even remember which payers they were. But I remember two separate circumstances, that happened with beyond that, you know, every week, there are several emails coming from my team to your team with payer enrollment errors that are as, you know, minor, not even minor but as basic as today where we had someone being identified as a licensed social worker, when that’s not the business that we’re in all the way to a month ago, when we were speaking, we had enrollment data from a provider who wasn’t even part of H ii health appearing in an H ii employees provider. And we had to ask for a specific person to be pulled off of our account and we had to ask for an audit to be done. And I still don’t have the results of that audit weeks later. So my level of confidence is very low right now across all payers. So this list, it doesn’t have a lot of bearing to me other than maybe these are some of the top payers that you guys are working on. But I don’t know how to get confidence and trust back at this point because it’s just continuing and snowballing. And the other thing that I would say to that is within the last month, I have given cliff’s information to another strategic PRN therapies has reached out. I have given his information to ovation which is another portfolio company of our sponsor. And I’ve gotten on calls with raintree to talk about the medallion relationship. And I’m at the point where I’m gonna call back all of those three people and say, don’t reach out because it’s not going well. And so this really needs to be solved. I’ve mentioned this before Peter. My team has no trust that anything is being done correctly right now because they don’t have to look very far to find issues. Shannon is great. I’m very grateful to have Shannon, but Shannon gets on the call every week and has to apologize to us. And I appreciate that. That doesn’t help me though.
Amy Frana (06:39) Now, I’m trying to be in the Amanda, and hear you very valid concerns frustrations, and understand where you’re coming from the audit that you’re referring to. Can you just, was it an all encompassing audit or just?
Amanda Streeter (06:56) So I can follow there was a specific employee named Manpreet. And I tell everybody that at my level of the organization. If I know somebody’s name at that level of your organization, there’s a problem that’s how bad it’s gotten. So there was a specific employee who was handling a lot of our enrollments and damn near everyone was wrong. And so that employee’s work had to be audited. It was something over, I believe… enrollments that person touched. And I have no confidence that any of them were accurate. And I have no updates on that issue whatsoever. Similarly now I have someone apologies, I can’t pronounce this person’s name, but who’s a credentialing contact on the issue that was identified today? So now that person’s name is on my radar, this is not good trends that we have here. So that was the context of the audit that I’m referring to.
Amy Frana (07:53) Okay. No, and I just appreciate you the clarity on that. So a couple of things that I hear you and I know Shannon ended up being out sick this afternoon. So I will get with her because I were working on putting together a corrective action plan for my understanding was the audit was done. But if information hasn’t gotten back to you, I want to make sure that we can get that finalized and summarized so that we can get that in your hands. A couple of kind of broader things that I don’t know if it’s been shared or if Peter’s had a chance to share. We do have a new coo that started a few weeks ago. He’s actually on site with a lot of our payer enrollment teams today. And this entire week, I know there’s additional training of leadership over there. We’ve added a training group here that is working on additional materials. So, I know a lot that’s not going to be able to resolve the frustrations that you’ve had up to this point. But I do just want you to know that all attention is on this matter with our payer enrollment team. Our coo has been directly getting involved and his main core focus is with our payer enrollment group. Let me follow up though on the audit piece and just some of the other issues that you’re mentioning with this new person that’s coming through so that we can make sure that we can adequately be giving you those updates and ensuring that the quality on those ones has been corrected if any errors were found.
Amanda Streeter (09:37) Yeah, appreciate the update… on company initiatives. I mean, if things aren’t getting better in the next 30 days, I’m going to be reaching out and saying we’re done with enrollments. We’ll take that back. You guys can keep credentialing. Okay?
Amy Frana (10:00) Yeah. I, and I think well, I know Peter, this is typically your meeting.
Amy Frana (10:06) I know Shannon has hers. So what we can certainly do and understand is bring forward. Like I said, I’ll work with Shannon, get everything laid out and find out in a way that we can make sure that you are seeing the progress over these next 30 days to better have additional information and clarity as you’re taking a look at how you’re feeling things are going in the next 30 days as we continue to implement some of these changes.
Amanda Streeter (10:39) Right now, the top priority for me is the accuracy issue. I would say secondary to that though is every time I get on the phone with my team, the issue of tasks being assigned for unnecessary reasons comes up to the point where like the savings that I thought I was going to get on reducing staff and going to outsourced enrollments is not materializing because I have so many team members reviewing tasks and the feedback that I’m getting is it’s tasks for stuff that is not applicable to us or incorrect or inaccurate. So that’s my other overwhelming concern. And those are also being reported to Shannon right now. I have, it feels like I have two full time people to just manage tasks and I would rather those people doing the enrollments ourselves because at least then I would know it was accurate.
Amy Frana (11:37) Okay. No, that’s valid. So I’ll get the details from Shannon on kind of just where she’s at in investigation and find out what additional support is needed. A quick question for you. Is this, I know that we’ve been with you for not long, but a while now, would you say that the issues are more prevalent more recently or have has your team been feeling this since we’ve implemented with you?
Amanda Streeter (12:10) I would say it’s probably been the case since we’ve implemented. Okay. But perhaps the issue with tasks is greater now because we have more, Peter would remember, we had a lot of on hold statuses that we were working to clean up. And so if we were to compare the volume of enrollments that are in process right now compared to six months ago, I think it’s probably quite a bit more which is a good thing that’s where we wanted to be moving towards. But all it’s doing is creating more tasks and more frustration.
Amy Frana (12:47) Yeah. No. I, that makes sense and appreciate the clarity on that. Yeah. And.
Peter Bosworth (12:54) I can, you know, as soon as we kind of hang up here, pass along some of the feedback around the 30 days and just… the urgency here and communicated across the organization. And yeah, I mean, I think we, Shannon is doing a great job to voice these concerns and I think it’s an execution issue rather than like a documentation of what needs to be done issue. Yeah. Amy, I wonder if we’re able to, yeah, talk… at all about, yeah, like what Nate’s or maybe some kind of shifts around the team that’s working on these or?
Amy Frana (13:43) Yeah. Yep. I can talk a little bit about what we’ve already done with some of the shifts, but then I do fully anticipate when Nate, our coo is back in office next week after his travels, I think we’re going to see some very big plans rolled out for even more quick fixes. But then also kind of longer term plans of how we’re going to get things turned around and quickly from the executional standpoint we have. So you mentioned Manpreet. We have rolled Manpreet off. We have been bringing in more senior individuals, that are being closely monitored and trained more importantly though I think just the shift in people is also the processes within quality control and quality assurance that we’re adding in.
Amy Frana (14:41) So all brand new employees that will be touching the account are going to be 100 percent audit or I shouldn’t say audited. Sorry, 100 percent qc’d for the first six months of their time with us. And then pending how their training and ramping progresses, it’ll be a certain percentage. After that. All in all, there is to be a longer term where 15 to 25 percent. I think the number is still being solidified but of randomized sampling for QA and QC when like across your account as a whole. So we have a lot more activity that will be happening proactively with these QC versus these reactive audits.
Amy Frana (15:31) But in the interim, too, we’ll make sure that the audit that was requested previously was complete. And if we need to increase any volume of auditing, we can take a look at that as well. But those are just a couple of the things that have already been implemented and working through. But like I mentioned, I think Nate, when he gets back, we can certainly introduce him to you as well. But work through and provide more of the updates of his plan with the operations team once he’s back from his trip.
Amanda Streeter (16:06) Yeah, that would be appreciated. Yeah.
Peter Bosworth (16:17) Is there the only other thing was just the… yeah, I mean, I guess we spoke about the superior health plan which we kind of chalk up again to like an execution error on a particular specialist’s part rather than a process issue.
Amanda Streeter (16:34) Yeah, no, you and I are on the same page there, Peter that’s I completely agree with that assessment. It’s definitely execution. And I before, when it was Tracy, I would have said, I don’t have confidence that things are being documented accurately. But with Shannon and also Vanessa joining the calls weekly, I actually do feel like they get it and can see what we’re trying to explain. They give us answers, you know, with how to manage things that are reasonable and appropriate, again leaps and bounds, better than what we were getting with Tracy. So appreciate that and kudos to them. But behind the scenes, the folks who are doing the work are an issue in execution, no question.
Amy Frana (17:21) Yeah. Well, I appreciate the feedback on the improvements with Shannon and Vanessa. I had hoped that would really straighten things out early and quickly, but you’re right? It’s that execution piece and that’s the piece where I just with Nate’s travel. He’s been traveling the last two weeks for various different onsites. I haven’t had a good chance to be able to really figure out and hear from him. Like where those focus efforts are going to be first. I know it’s on those that are frontline agents and how we’re going to leverage our training team to more quickly make sure our QA team and QC team to be able to do validations to start building that confidence on the execution side. But we’ll be sure to share as soon as we have more when he is back next week.
Amanda Streeter (18:11) Okay. Two things that I will add to that are surprising to me and are going to escalate quickly. One is we’ve been told that we can’t put an application in for something while an application is in progress. And I don’t have the details of this, but that was really surprising to me to hear Shannon and Vanessa say that would have to be a system enhancement to address. And I can’t imagine that it isn’t something you would see across organizations of our size and type that are growing as fast as we are. Like I have a location opening every month and I have acquisitions closing every month. So if I can’t have an application submitted while another application is in process, it’s going to come to a screeching halt within days are.
Amy Frana (19:03) You, so just to make sure.
Amanda Streeter (19:07) I’m not going to be able to articulate this well, Amy, I’m sorry, I just know that I listened, no.
Amy Frana (19:12) That’s okay. You’re so I can follow up with them too. I’m thinking what you’re meaning is like we would already have an application in and then we’re needing to add in an additional location or something because you’ve closed. Does that sound correct? Okay?
Amanda Streeter (19:28) Yes. Okay.
Amy Frana (19:29) Perfect. I just want to make sure when I ask, I’m asking it correctly, so I can understand where they’re at. Yeah, yeah.
Amanda Streeter (19:36) The second thing too is rbts registered… behavior technicians. They’re part of the Aba program. We’ve brought this up a few times. These are employees that oftentimes have at best a bachelor’s level, sometimes just a high school diploma and a two week certificate. We are not going to have caqhs and the like and five years of employment history for these folks. And the system just doesn’t accommodate their provider type well, and that is probably our biggest area of turnover in staff. And I have to be able to do enrollments efficiently for them. And right now, I don’t even know if our team is bothering to submit them because they’re just going to get 20 tasks back for an rbt, they’re just going and taking care of it themselves. And that is an area of the company that I have active discussions with acquisition targets to grow Aba services and it’s going to be an even bigger pain point in the very near future.
Amy Frana (20:46) Understood is that, are you, are they billable? Okay? And.
Amanda Streeter (20:53) There’s only a handful of payers that actually require credentialing for them. But to just, you know, and that makes it even more frustrating to be honest with you if it’s just medicaid and tricare, that requires them to be credentialed. Now, we’re doing 20 tasks and we’re only getting two enrollments out of it. And so, it’s even more frustrating at that point. So again, my team is like, well, forget it. I’ll just do it myself and that’s not efficient for us, no.
Amy Frana (21:20) Not at all. Okay. Let me follow up with them to understand what work they’ve already done on that. But hear you that those are two of the biggest especially with the rapid growth that you’re having. And so I have that documented so I can take it back and understand where we are and what next steps would need to be to help improve.
Amanda Streeter (21:41) Okay. So.
Peter Bosworth (21:43) On the rbt issue, is it, I want to like try to isolate what fields in medallion. We need more lax requirements around specifically. And if it’s like professional history, it’s the five years and then education. Is there anything else? Yeah?
Amanda Streeter (22:02) This is where I’m also not a good reliable resource to answer that, Peter. So I’m sorry because the team would know better than I would. I want to say that these folks might not even have a caqh to be honest with you, but we can definitely, if we need to provide that information, we can definitely get it to you.
Amy Frana (22:23) Okay. Yeah, we can take a look because somebody within my team even if it’s not Shannon or some people in our ops will have experience with it so we can review, they wouldn’t have a license then either, because if you’re mentioning that they have a certificate, they probably don’t have even an npi or license or anything.
Amanda Streeter (22:46) Well, you know, Aba is kind of the wild west by state too. And so there’s a lot of state nuances to who has to be licensed and who doesn’t in the state. So I don’t even think that that’s an easy yes or no answer. Honestly? Okay?
Amy Frana (23:02) And that’s fair. So, yeah, let me follow up with Shannon and Vanessa. I don’t know. Yeah, like I mentioned, they might not be the right people, but I know I have folks on my team who likely do have more experience with those and we’ll tap them in and bring them in to help support them.
Amanda Streeter (23:20) Yeah. And I think the context of some of the conversations was they will never get to above 85 percent. So with the requirements that are there that we’ve been talking about. So, yeah. Okay. Yeah.
Amy Frana (23:33) No, I can appreciate that and understand that. So. Okay.
Peter Bosworth (23:43) Yeah. Sorry. I’m just looking at some rbts. It seems like we’re able to like we’re processing some enrollments without a full professional history. But yeah, let us, let me get into the weeds more on this. Yeah.
Amanda Streeter (24:00) And if you need information from us, I’m sure Tamara and Colleen would happily provide it. Okay? Appreciate it.
Peter Bosworth (24:08) Okay.
Peter Bosworth (24:08) Thank you. So we will… kind of regroup on this audit piece. And then also an introduction to Nate. I know that Nate was out of town last time we spoke Amanda. Yeah, or this week, but he’s.
Amy Frana (24:26) been traveling a lot and he had some time off right? When he joined, but I do believe Peter, he’s back fully next week, okay?
Amanda Streeter (24:34) Great. And I know that as of last Friday, I didn’t have an audit result. I’m just looking to see if Shannon would have sent something since last Friday, but I don’t think I’m leading you astray on needing an answer to this. So it would be much appreciated. I would feel much better if I knew those records that Manpreet had worked had been reviewed. Yeah, she.
Amy Frana (24:56) Had sent me something about those specifically earlier today. Yeah, but she didn’t give, she said we did it, but she didn’t give me all of the specifics. So that’s why I think it is done. But let me just follow up with her so that we can get the analysis over to you.
Amanda Streeter (25:16) Okay. Thank you.
Amy Frana (25:17) Yeah, you’re welcome. Okay.
Amanda Streeter (25:23) Thank you, Amanda.
Peter Bosworth (25:24) Yeah.
Amanda Streeter (25:25) When are we scheduled to talk again? So I don’t lose track of it?
Peter Bosworth (25:28) Two weeks from today, but happy to edit.
Amanda Streeter (25:33) Yeah, that should work on the thirtieth, I can do that.
Peter Bosworth (25:37) Okay. All right. Great.
Amy Frana (25:41) All right. Appreciate it. Thank.
Peter Bosworth (25:43) you, Amanda. Thank.
Amy Frana (25:45) You bye.