Transcript
Lee Fuller (00:00) hey, Mira. Hi.
Mira Guha (00:01) Lee, hi, Adam. How are you both… doing well. Great, Adam. I don’t know if we’ve been on a phone call together in which case, it’s nice to meet you or good to see you again.
Adam Puttkammer (00:13) Yeah, nice to meet you as well. I’m in the car, so it won’t be on camera but wanted to listen in. I don’t think Lee’s been handling most of the medallion stuff. And… now that we’re at where we’re at, I had some just general questions and then obviously, we’ve got to update our proposal. Okay? Yeah.
Mira Guha (00:32) Sounds good. Happy to take any feedback. I don’t know if you’ve had a chance to look at just how we’ve changed consumption since we last met a few weeks ago. So, I did want to just like check in on that since we are consuming maybe a little faster than we thought we would. But happy, to start with any of your questions, make sure we’re addressing any items or updates on your end for sure.
Lee Fuller (00:54) So, my first question, so I was reviewing the amended proposal.
Lee Fuller (01:01) In our last conversation, we talked about how our new licensure was slowing down and, the renewals were going to be taking more of, the front seat here. On this proposal. I see that it’s still listed that we’ve got state licenses, new marked as 200 units, and it’s got renewals listed at 100. So, can you explain why that was set up that way?
Mira Guha (01:24) Yeah. Let me share my screen. That was really just based on primarily the consumption as of today since that is where we’re seeing so much of the current usage as well as what’s queued up. I wanted to revisit. This is what we last showed on. I think April second, when we met, that’s just total usage. This is today. So, as you can see compared to last time we met, we’ve actually consumed about an additional 20,000 dollars against your contract. And a lot of that has to do with the new state licensing. As you can see as of April second, we actually had 114 new state licenses in medallion that hadn’t been consumed against your contract yet. So that’s obviously a huge portion of the 200 that we had listed, as of today that’s up to 185. So.
Lee Fuller (02:12) You’re saying from the time that we spoke in April till now, we have consumed even more new state licensure?
Mira Guha (02:21) Yes, consumed and requested. Let me just go ahead and pull up your platform as it is today. So you can just see, I realize the one thing I didn’t include here was the actual as it stands today, number of new state licenses consumed versus what was allocated for year one. I thought that was in here, but let me go ahead and just show you it’s. Probably helpful to get a good sense of just current state live metrics anyhow. So, and Adam, I realize you might not be able to see this if you’re behind the wheel, but I’ll go ahead and share after the call, just some of the metrics here. So as of today, once this loads, as… you can see right now, 180 new state licenses contracted for year one, we’ve exceeded that by 117. And on top of that, so, those have been consumed, they have completed intake and are in a workable status that’s how our consumption logic works. On top of that, there are 185 new state licenses that have not yet been consumed. We have not completed intake and put them in a workable status. But once they are, those will continue to further affect the total contract dollars. So.
Lee Fuller (03:30) Are those, the, are those the providers on the far right column?
Mira Guha (03:33) Yeah. So, what you can actually do if it’s helpful, this is an interactive dashboard is you can look and filter by just new state licenses and see exactly which provider is queued up for this.
Mira Guha (03:46) And then you can actually, if you want to click on that new state license and it will, it should take you to that request so you can see, but we’ll provide the SKU and the name.
Lee Fuller (03:54) Can you just scroll through that list for me real quick since you’re in there just so I can see who?
Adam Puttkammer (04:00) And, you guys haven’t started this because we need this renewal sign before you guys all activate them. We.
Mira Guha (04:07) Can work on these? These have not been consumed yet because we haven’t been able to start working on them either because we need something from the provider. There might be an open task or profile requirement or if it was just requested, like a lot of these are from yesterday, our team might just not have gotten to them yet. So the status will tell will give you a sense. I can also send over a list of statuses and confirm which ones are considered workable. So then it’s consumed versus non workable. Like if it’s pending dependencies, like you put an request for an NP, but they don’t have their RN in that state yet. Like here’s, an example, we might not be able to work on it yet. So it looks like a good number of these. You can also, I think order these. You can export this from the platform are from yesterday. It looks like we received quite an influx of requests yesterday alone.
Lee Fuller (04:55) So, Adam, the bulk of these, I know you’re driving bulk of these are happy healthy and lean with a small portion of them being Alicia for virtual care.
Adam Puttkammer (05:06) Makes complete sense. Yeah.
Mira Guha (05:08) So as of right now, current state, we can initiate work. The only thing is we might start having finance taking a look at where we are if we don’t have an addendum signed in the next few weeks, and if we continue consuming at this rate, sometimes they step in and set a deadline. I know we’re looking to hopefully have this wrapped up pretty soon, but, I do want to make sure like we’re answering all your questions. We’re right? Sizing this as much as possible. I know this is still probably part of that peak. So we kind of if you could consider it as like a spreading out the new state licenses. I think we have it like 200 for each year, but I do think that’s probably pretty accurate given where we are right now and the additional 185 queued up for new state licenses.
Adam Puttkammer (05:49) So, how much were in our current agreement? Were we allowed to consume,
Mira Guha (05:55) I can go ahead and pull that up. I can’t remember if we had more allocated for year two than year one. We’re still in year one, first year of the contract, we had 180. I think year two might have been the same. I’m gonna backtrack myself here. Just pull up your contract. I talk to lots of people. So I don’t want to speak out of turn until I’ve actually checked, get you mixed up. So current contract, we had 180 new state licenses in year one and 180 in year two.
Adam Puttkammer (06:26) And we’ve consumed 207.
Mira Guha (06:29) 297 two.
Lee Fuller (06:31) 97. And.
Adam Puttkammer (06:32) How many is that including the ones in queue?
Mira Guha (06:35) That is not including the ones in queue. So.
Adam Puttkammer (06:38) We’re over 117 here. And then another, how many?
Mira Guha (06:44) 185. So, even if we were counting all the 180 we have for next year, I think we’re still gonna land above that for new state licenses, which is why I, we budgeted pretty high in that addendum, we can adjust if you don’t think we’re gonna have any more new state licenses. I think the last time we talked, we budgeted based on that like 25 buffer you mentioned and just where we were with the current kind of requests consumed and queued up, it just does look like we’ve seen quite a spike in those that have been queued up and some have probably also consumed in the last two weeks or so since we spoke.
Lee Fuller (07:17) Yeah, Adam, I think maybe you and I need to have a conversation with Candice about what she has left in the queue for new state licensure for happy, healthy and lean, because I think we both thought that was already in progress and it doesn’t seem like it is especially if she’s started requesting licenses as of this week, for providers?
Mira Guha (07:38) Oops, I’m trying to find.
Adam Puttkammer (07:41) a pencil. So we were, we had 180 that we were allowed to have each, year one and two,
Adam Puttkammer (07:53) So, we’ve already consumed, we’ve consumed 297. And then how many are, in flight… one?
Mira Guha (08:05) 185 for that particular contract SKU for that particular license type. And if you don’t want us to work on any of those, you do have a little leeway right now. You have a little wiggle room, to stop any of those requests as of right now. As soon as our team initiates work, those are going to be consumed. I’m guessing they are needed based on the happy healthy and lean kind of project plan. But as of right now, if you wanted us to stop any of these and then remove them from the projected usage for the addendum, we could, but this is the current state and if we do nothing right now, they will be consumed against the contract.
Adam Puttkammer (08:40) So right now, we have an overage of 122 and what’s the new proposal? Yeah?
Mira Guha (08:47) So I don’t think I’ve actually updated it since I chatted with you last. I also think a lot of these new license requests that came in yesterday probably will kind of affect how we want to adjust. What I went ahead and did. Most of these are the same slides we went over last week. And then I put in new ones based on current state. We budgeted 200 additional licenses for this current contract year, and then another 200 for the next contract year. So, is that?
Adam Puttkammer (09:12) Above and beyond the 360 we have or is that moving the?
Mira Guha (09:17) Number from one?
Adam Puttkammer (09:18) To yeah.
Mira Guha (09:20) So basically, this addendum would combine with your existing agreement, they would co, terminate at the same time. So instead of having 180 new state licenses budgeted for year one, if we sign this addendum, that number will increase to 380 new state licenses for year one, 380 for year two. We can definitely finesse that a little bit, make sure we’re right? Sizing that as much as possible, you still have dollars left on your total contract, but obviously, we’re way over year one and our protocol is once we reach 120 percent of year one, we have to sign an addendum we’re lower on certain other SKUs, like we’re underutilized on, I think renewal licenses and a couple other things. But the new state licenses are a more expensive SKU, just more work involved there. And we are significantly over consumed on that particular SKU.
Lee Fuller (10:10) Mira for year two, though we’re going to have to flip the numbers for renew versus renewals because that 100 is not going to.
Mira Guha (10:19) Get us there, okay?
Lee Fuller (10:20) Yeah. And we’re going to have, I mean, Adam, correct me if I’m wrong, but in year two, meaning in 20 27, we are not going to have nearly what we have for new state licensure. So do we know?
Adam Puttkammer (10:31) I mean, the rest of the rest of the, realistically, the rest of like hhl might hire one more provider, something, you know, somebody quits, somebody gets fired. So, you know, I think you and I have to consider, you know, one or two more providers. We got to think about virtual clinic because that comes on board for virtual.
Lee Fuller (10:55) Care. I’ve mapped out needing five to six providers. So like the new mirror?
Adam Puttkammer (11:02) Licensed in how many states?
Lee Fuller (11:04) Well, I’ve talked to Jen of how many states she wants to be licensed in.
Mira Guha (11:09) Okay. So.
Adam Puttkammer (11:11) And then we just have to think of our brick and mortar and I don’t think we’re going to add that many new people in those. So I think what we need to do Lee is next time you and I connect, we just need to sit down and crunch these numbers and then figure out what we think we need above and beyond the… yeah.
Mira Guha (11:31) And I’m happy to go ahead and start making some of the adjustments based on the feedback today. As far as new state licenses, where we are this current contract year, how that’s going to adjust for year two? And then like you said, flip it. So we’re seeing more renewal licenses available for year two compared to what we have allocated here. I’ll also see if we increase the new state licenses in either contract year quantity wise. I know last time we talked, we were looking for a little preferential pricing there. So if we are open to increasing those numbers, we feel safe committing to that. That usually opens up that preferential pricing based on our bulk discounting method here. Any other questions or updates? It sounds like there just might be a little more thinking involved to just get the numbers down for future state projections for the remainder of the contract. But any other feedback on other volumes or anything else we might want to change here?
Lee Fuller (12:25) I mean, my only feedback is we’ve got to flip year two with more focus on renewals? What I’ll do, Adam, I will ping Candice and ask for her to provide a list of what outstanding licensure she needs for hhl and any of the forum health providers with virtual care. So I can see if we’re in some type of backlog. And then when you and I connect, I’ll have that information so we can go over where we have the future growth there.
Mira Guha (12:57) Great. If possible, would we be interested in?
Adam Puttkammer (13:00) I think the other thing Lee on renewals is, I think we’re going to have a lot more renewals in 28 because most of these licenses are for two years. And so, I think you’ve got 20, you know, a bunch of people that just got licensed in 26, and now you’re going to have a break in 27, and then you’re going to have a major renewal year in 28, yep.
Mira Guha (13:25) And there’s data in medallion to track expiration dates for existing licenses we have. I think I might have shared that before, but happy to send instructions on how to kind of start factoring that in, based on, yeah.
Adam Puttkammer (13:36) I mean, if you can give us a report that says here’s when the renewals are for the current people in queue, that would be helpful. Yeah.
Mira Guha (13:42) I’ll go ahead and I’m going to see if I can export the upcoming spend for you as well as upcoming license expirations between now. And let’s say, end of contract, I can see if I can break it up into year one and year two of the contract.
Adam Puttkammer (13:57) In mirror with the oh.
Lee Fuller (13:59) Go ahead I.
Adam Puttkammer (14:00) Was just going to ask a general question. Do you know if we have a provider and they get licensed in 50 states, what it costs? The difference between like a physician and a nurse practitioner?
Mira Guha (14:12) Yeah. Good question. So if we go the traditional renewal route for either provider, any license renewal, traditional route is the same rate. It falls under that state licensing renewal SKU. If a physician MD or do is eligible within the compact, the imlc and we want to go the compact route. That is a cheaper SKU. I know you probably can’t see this, but that’s factored in here. It’s that imlc licensing post loq, we can go that route for compact for new state licenses or renewals, if the provider is participating and the state is participating. So it really just depends on which route there is a nurse licensure compact, but that just really pertains to RNS. So I can send information on both. And then there is data and platform. You can track whether like we went through the compact and we’re compact eligible. Again, we still need to check every time because sometimes people move Michigan almost left the imlc as you probably know earlier this year, things can change. So I can go ahead and send information on the different compacts. And then you can help use that for some of your decision making. But I believe we used some data in platform to factor in where we were trying to go compact versus non compact for, yeah, but.
Adam Puttkammer (15:26) I’m just trying to get a ballpark number of like between the state fees and your fees. Is it legitimately like, I think Lee gave me a number of like 60,000 dollars to get one provider licensed in 50 states. Does that sound right?
Lee Fuller (15:41) It wasn’t 60,000. It was 22,764 dollars and 75 cents.
Mira Guha (15:48) I think between our costs plus all the pass through fees, which is like the state board fees, getting the things you’re talking about.
Adam Puttkammer (15:54) Yeah.
Mira Guha (15:55) We do have a calculator like kind of, we can put together a couple examples for you that’ll say like based on our most recent estimates. And again, it is just an estimate because things change all the time if you want to obtain a new state license for an MD in Nevada. This is kind of an estimate of what you might see total for pass through fees alone. So we do have a little bit of data that we can share on some certain examples for you. I can go ahead and put together a couple based on like common states we’re seeing for you. I know you’re doing a lot of 50 states, but for it sounds like maybe MDS and NPS, but yeah, the pass through fees unfortunately is a lot of where they get you. We pay as many of those as we can up front and then ask for reimbursement from you… reimburse get those reimbursed at cost. So we’re not upcharging you for those. So you’re going to pay those anyway, even if you were to try to obtain the license yourself. But some of those pass through fees can be really high depending on the state.
Adam Puttkammer (16:53) Got it.
Lee Fuller (16:54) Adam, do you want me to send the file that I got from Kyle who’s our rep? So you can just have it for reference for each state, what each state costs?
Adam Puttkammer (17:02) Yeah, that’d be helpful. So, is it right then between their fees and the… state fees, that is 60 grand to do that?
Lee Fuller (17:13) 20… 200? Let me just do quick math.
Adam Puttkammer (17:25) I mean 500 at 50 is 25,000. So, right there you’re.
Lee Fuller (17:32) yeah. Well, I mean, the, what numbers I pulled were for the compact license? So that’s an additional 5,000. So you’re looking at just shy of 30,000 for it. If we’re not doing the compact license and we’re doing just straight new licenses then… yeah, it’s just shy of 60,000. I.
Adam Puttkammer (17:54) Mean, we’re always doing compact when we can, right?
Lee Fuller (17:57) Yes. Well, now we are. Yeah. Okay. Under the new contract, the old contract we didn’t have, we didn’t have the imlc as like a heavy user. Okay? Mira with this amendment… time, if we were to consider doing something for year three with just the idea of, you know, our renewals are going to be heavier in year three. If we were to commit to something like that, can we drive our costs down for these different categories?
Mira Guha (18:36) Gotcha. Like doing a contract extension into a third year? Yeah.
Lee Fuller (18:40) Because I’m just thinking if the bulk of this is going to come in year three, we might as well plan ahead and I would like to get these price per units down even further than what we already have.
Lee Fuller (18:51) And you can kind of see our growth. So, you know, to whoever you need to get approval, you have the data to show that we have significant volume that’s coming. Let.
Mira Guha (19:02) Me, go ahead. That will be probably some decision made by our executive team or our am leadership team. I’m going to go ahead and relay all the feedback from our call right after this and see if they might be open to that. That might mean like repapering the entire contract to get us on a three year, but I know in some cases, we can give preferential pricing for a longer term commitment. So I’ll definitely run it by them and see if they have thoughts on if we’d support that and what that might look like, yeah.
Adam Puttkammer (19:29) Before you do that, let me and I run some numbers so we can get you some where we need to be at, and then we can go from there. Okay that.
Mira Guha (19:36) Sounds great. Do you think you have an estimate on when you might have some of those projections? I think it’d be great to have something on the calendar if possible, but want to make sure we give you enough time to start factoring in some of those updates.
Lee Fuller (19:49) Adam and I meet every Wednesday afternoon. So… next Thursday afternoon would work for me great.
Mira Guha (20:01) Remind me what time zone you’re in, I’m Mountain Time.
Lee Fuller (20:04) I’m eastern. So right now, I’m available at one eastern if that works, I.
Mira Guha (20:10) Should be able to do that. Let me go ahead and get that on the calendar. And I’ll check in ahead of time to see if like, you already have the numbers. Maybe I can already send over a new proposal. So I’ll check in the day before. I don’t know that we’ll have, you know, everything figured out and taken care of by end of month, but want to give you a heads up. I’ll put this in my follow up. I’m out of office, the 20 eighth through may fourth. My, the manager of our account management team will be covering for me. So, if you have any questions or updates, I think she’s copying on our threads right now, Genevieve, sini, Gabrielle Norton runs our am team too. So she’s copied as well. So, if you have any updates or questions, they’ll be covering for me. They might also even be able to get you faster answers on things because they have a little bit more input on this sort of thing. So, I’ll go ahead and I’ll send a follow up after today. I’ll go ahead and get 30 minutes scheduled for us at one PM Eastern Time next Thursday, and we’ll go from there. Any other questions for right now?
Adam Puttkammer (21:13) Nope. I’ll get on my side.
Lee Fuller (21:15) I’m good as well. Okay?
Mira Guha (21:16) I’ll go ahead and share just the slides from today, so you can just have a quick snapshot.
Mira Guha (21:20) I’ll send over the exports I just mentioned, let me know if you have any questions or updates and we’ll plan to, check in next week.
Lee Fuller (21:28) Okay. Thanks, Mira. Thank.
Mira Guha (21:30) You both. Thanks. Bye bye.