Transcript
Sarah-Dina Durand (00:00) hello there. Good.
Kelly Chang (00:03) Morning. Good afternoon.
Sarah-Dina Durand (00:07) We made it to Friday to?
Collette Waddell (00:10) Friday. Yeah. Hi, Kelly. Hi, Jenny.
Kelly Chang (00:17) Hey, bye.
Collette Waddell (00:19) Happy Friday.
Collette Waddell (00:27) How are your weeks going? Or how were they? Can you hear me?
Yenny Zhang (00:35) Oh, sorry. My mic was off. Good. How about you? How’s your week? Glad it’s Friday, me too. All right?
Collette Waddell (00:46) Sarah is in the waiting room, so I’m going to go ahead and let her in.
Collette Waddell (00:55) Hi, Sarah. Hey.
Yenny Zhang (00:57) Sarah. Hi.
Sarah-Dina Durand (00:58) Everyone. Good afternoon. Good.
Yenny Zhang (01:02) Afternoon.
Sarah-Dina Durand (01:06) Happy Friday. Lou might join us a little late. She just has another meeting that comes right now. She couldn’t move, but I’m more than happy to help answer any questions and dive into the plan.
Yenny Zhang (01:28) Awesome. You know?
Collette Waddell (01:29) Real quick before we get started, is Desiree going to be joining? Like, should we wait for her?
Sarah-Dina Durand (01:34) No, Desiree. It’s just me today, okay?
Collette Waddell (01:37) All right. No worries. Just want to make sure.
Yenny Zhang (01:43) Okay. Well, thank you, Sarah for being here with us today. So, the purpose of today’s call is to finalize and understand your ongoing monitoring review workflow.
Yenny Zhang (01:54) And today, we’ll be answering some questions or sorry, asking some questions by showing a possible end to end platform ongoing monitoring flag review workflow. And we’re not committing to building everything that we’re going to show today. So, our priority is to just understand what we need to build primarily to ensure that you’re able to use our product to demonstrate ncqa compliance. Does that sound good? Sarah?
Sarah-Dina Durand (02:24) Yes, awesome.
Yenny Zhang (02:27) Okay. I’ll let Kelly take it away then, since she’s been owning a lot of the design work. Yeah.
Kelly Chang (02:33) Let me share my screen.
Kelly Chang (02:41) Cool. Can you guys see this? Yes. Okay, perfect. Cool. So yeah, I’m going to just take the next few minutes to kind of walk through this prototype and then afterwards we’ll kind of use this visual to guide us in some of the questions that we want to ask around the specific review workflow.
Kelly Chang (03:05) So yeah, what you’re looking at right now is essentially what could be the home page for ongoing monitoring. So you can see on the left we have like other medallion SKUs and products. And so when you click into ongoing monitoring kind of the landing page, is this like needs review queue? And essentially what this is essentially we would be surfacing all of the new flags that come up. And then you can see here on the flagged dates, this is essentially like when we found the flag. And so the idea of this is to be like a working queue to go through each provider and go through the review process. And then the escalated tab are providers and flags where we need that like medical director review… obviously, we’re building this so that it can be used across multiple customers. So we’re not calling this specifically like medical director review. I think the idea here really is when we need like a second reviewer, it would go into this bucket of like escalated flags which we could, if anyone has any feedback to around like what this should be called, feel free to add that. And then this last tab is essentially a resolved flags. And so once it’s gone through the entire review process, all of the providers would come here with their flags and you can see the outcomes are listed here. So, yeah, I’ll walk through like what it would be like to go through a review process on a level set like how all of these tabs work. And then one thing to note here is, yeah kind of what I was mentioning before it’s designed to be like a work queue. And so we would flag or order basically this list by the oldest date that we found the flag. I think within ncqa is within three days. So obviously we want to call out if that’s past that date. And then you can see here if a provider has multiple flags, the idea here is that we would show, we would still order it by the oldest flag. So here, Emily browning, for example, has medicare opt out and mpedb even though mpedb was flagged four days ago, we would still show it because the medicare opt out is like 38 days. Okay? And then something to also know is here, I have added these filters to like work through by flag type. And so for example, if I wanted to do only mpedb. I would like click review mpedb and get to the review screen. And here you can see it’s just one of nine providers with mpedb. And so all of these providers have that. So yeah, that’s just like another quick action if you wanted to review by the flag type. Okay? So I’ll go through an npdb example. So when you click into a review kind of page, we would show the provider information and then the primary source information. Something we’re thinking about too is having the ability to sort of summarize, like the report, we know right now on platform. The npdb report is quite long and it might be a little bit hard to like parse through. So npdb has like a specific code list so that’s what it shows here. And then when you go into the review, you can basically add notes in response to the primary source. So I’m just gonna say adding notes and typically my understanding for npdb actually it probably depends but I’m just gonna escalate it for this demo. So here, I could escalate it here and then work through to the next provider adding random notes. Maybe this provider, I don’t need to do any action. And then for, because… I’m in the npdb review something and we’ll have follow up questions around this. But for example, if Jennifer had both medicare opt out and npdb in this screen, you would be able to review both flag types. So here, I could just say like, you know, an updating system but here, maybe I have like a longer note in response to the npdb report. And the thing to call out here is in this workflow, you would be either selecting an outcome, you’re selecting the outcome for the provider, essentially with the flags as input rather than selecting an outcome for the flag. So here for Jennifer because she has npdb for example, maybe I would escalate, but if let’s say like this provider only has medicare opt out, I would probably only just put no action needed. So yeah, that’s something to point out and we can discuss more when we’re asking for feedback. And so once you get into the escalated view, when you click into Jane, there are a few more outcomes. So something we also will want to validate with you all if these are in the first stage, that was the right set of outcomes. And this stage is also the right set of outcomes. So as the medical director, maybe I look at this and decide to suspend the provider. And then I would submit the review here. Maybe for this one, I say no action needed. Yeah. So that’s kind of how it would work. The flow is very similar to what it would look like for the initial reviewer. And then when you get to the resolve tab here, you can see all of the providers that you’ve worked through. So right now, the most important really thing that I’m showing is the outcome and who the outcome is by. So it could be, you know, the credentialing specialist or maybe it’s the medical director outcome date. And then when you click into it, you can essentially see kind of the full like story of all of the notes added. And then the report… cool. So that’s and then one more thing is the expired license. So I know this is something we have talked about and so very similar to the other workflows is if we were to be able to add expired license, it could look something like this where we show the primary source we have the provider license data. And then you would basically go through the same workflow of either escalating or no action needed for the expired license. Cool. And then something we’re also thinking about is how it relates to the rest of medallion. And so right now in the providers tab, you know, we have all this information here and there’s actually a column right now called requests. But if we add ongoing monitoring, maybe we would want to rename it to products. And here, you can see monitoring is enabled for these providers, this list and this demo is just all of the providers that have issues found that’s why there’s like all of them have mostly issues found and you can see if they were reviewed or not. And then if you click into it, you would basically be able to see like a historical record of like all of the checks that we’ve run per provider. Yeah. So that’s kind of how it like fits into the broader like medallion ecosystem, which is again something we want to validate with you all that. Just like the importance of this. Okay, cool. That walks, I think walks through everything. I know that was a lot. So we definitely want to dig into more of these specific workflows to make sure that, you know, we’re capturing everything, right? And solving for the right problems. So, Yenny, do you want to start with the questions or do you want me to kick them off? I guess Sarah, do you have any initial reactions to the walkthrough?
Sarah-Dina Durand (10:49) Of course. Yeah, thank you. This looks really great. And I’m super excited for potentially using this. I, the one thing that I was looking at for the expired license tab, we wouldn’t need to escalate any of those to like medical review. It would just need to be like marked as, you know, license reviewed removed from campus compass or like license reviewed, providers, not seeing patient in that state or something like that. Yeah, but essentially, it would just be marked as like reviewed or like pending renewal or like state deactivated something like that would be the outcome and we wouldn’t necessarily have to escalate it to medical director.
Kelly Chang (11:46) Yeah.
Sarah-Dina Durand (11:48) So I think the options of outcome should be a little different from the other. Yeah. And that’s the one thing with that and for the actions. So, if a provider has two actions like the medicare opt out as well as npdb when we’re reviewing and we want to escalate, it would just be an escalation for the both of them. But we can clearly like add a note to say, you know, I don’t know the tag was updated like providers, not seeing medicare advantage members, but once we escalated, it would look like both of them are being sent, right?
Kelly Chang (12:40) Yeah. So this is, so, yeah, this is actually a topic we wanted to kind of walk through and it’s really just kind of like the mental model of how we think about flags and how it relates to the provider. So, yeah, you can see in this screen here, let’s say, yeah, medicare opt out, right? It’s you know, you’re just saying updating system whatever. And maybe mpdb is a very serious action. And so, in this case, I escalated. And then if you go to the escalation tab with the providers, the two, you would be able, the escalator like the reviewer here would be able to see the notes that you had provided per flag. And then essentially, what they’re doing is they’re deciding an outcome for the entire provider? Yeah. So that’s kind of like how that works? I guess, like a follow up question is like, is this sort of like the mental model that, you think about? Or is it, does it make more sense to you when like, in terms of review to just review like per flag and not necessarily have this like higher up relationship to the provider? I.
Sarah-Dina Durand (13:49) think this is great because sometimes like you’re in one tab, you’re like I wonder if something else is going on. So it’s good to have them all in the same section. I think the notes will act as that like clarifier of like what we’re escalating versus not. So I think this is great. I just wanted to clarify how that would look on the reviewer’s end. But yeah, this looks great. Yeah.
Collette Waddell (14:15) Just to follow up, Kristen Kelly. Yeah. Like I think to what I agree with what Sarah’s saying in terms of like presenting it in like a single screen, it kind of reduces the risk of like some alert not being reviewed or reviewed timely. But kind of immediately where my thought process like goes to, right? When I kind of view this is if, and I don’t know if it’s feasible but to like select an outcome in the same screen, but per flag… does that make sense?
Kelly Chang (14:53) Yeah. I know the.
Collette Waddell (14:54) Notes is kind of the idea, but I feel like it… could possibly eliminate any confusion or misuse of what, how it’s intended to be used if there was like a select outcome like at like two of them in this like example, for example, you know what?
Kelly Chang (15:14) I’m saying. Yeah. So it’s selecting the outcome per flag, not at the provider level, right? Is what you’re suggesting that’s kind?
Collette Waddell (15:21) Of like immediately where my mind went, Sarah does that?
Sarah-Dina Durand (15:26) Yeah, I.
Collette Waddell (15:26) mean, as a user, who is, you know, needing to kind of manage this type of work? Does that, am I on like the right thought?
Sarah-Dina Durand (15:35) Process? Yeah, I think that makes sense. I think again, I think it was just eliminate any confusion of like, okay. What am I reviewing? Versus like what’s already been like reviewed by me or, you know, whoever reviewed it before. So I think that makes sense if we’re able to like have the outcome per like or per flag versus like, yeah, the whole provider review. I think that would make sense. And I think it would.
Collette Waddell (16:05) Eliminate any because I feel like there could be some instances and it would vary on customer or what the flags are, where one of them is like no big deal like, you know, we’re required to monitor that, but like we don’t have to like do anything with it. But then the other one on the same view could be like this is like major like we really need to, you know, move that into like an escalation? Yeah.
Kelly Chang (16:28) No, that totally makes sense. So it sounds like we like the kind of presentation of aggregating information to a provider, but the like outcome action still would be helpful to have it tied to like the single flag. Is that right?
Collette Waddell (16:43) That’s kind of where my just immediate gut like response is, yeah. Yeah.
Kelly Chang (16:49) Totally beautiful. Cool. Yeah. No, that’s really helpful feedback. Thank you. Okay. Let’s see. Yeah. And then the kind of next question around this like outcome is you can see like right now for the needs review stage, I only have like no action needed and escalate as the outcome like for this initial review. Whereas if you’re in the escalated stage, you have like the committee provider suspended terminated. I think something we wanted to validate is like what are the kind of actions or outcomes that could be selected like per stage depending on? I don’t know if like in the initial review, you would be able to just decide like a provider suspended or terminated or that just only can happen in that escalated stage?
Sarah-Dina Durand (17:51) I’m trying to think that would only happen at the escalated stage because I wouldn’t make that decision. Ultimately, the medical director, would I’m, just essentially just like flagging it to him to kind of review or if I’m flagging it to myself to kind of take action on then like that’s it, but I wouldn’t necessarily decide on anything.
Kelly Chang (18:16) Yeah. Okay. And then in the like escalator like outcomes, does this list look right to you or are there kind of other sort of outcomes that could happen? And yeah, if we think about it per flag type, it might make.
Sarah-Dina Durand (18:33) More sense. Yeah, I’m trying to think… no action.
Sarah-Dina Durand (18:46) I think instead of no action, we could say something like file reviewed and like because we don’t want to say that we didn’t do anything with it, but rather we reviewed it and decided to like keep the provider on. So something that would like capture that I don’t know like.
Collette Waddell (19:05) No further action.
Sarah-Dina Durand (19:07) Right. Yeah.
Collette Waddell (19:10) Yeah.
Kelly Chang (19:11) Like flag reviewed or flag, yeah, something maybe more? Yeah, just clearer than no action needed. Cool? Yeah, I think that makes sense. Awesome. Yeah. And in terms of like copy actually like do you think escalation kind of the verb escalate and the category of escalation? Makes sense to you as that kind of like second stage of review? Yeah, I.
Sarah-Dina Durand (19:38) think so. I think if we’re trying to be more like generic and not saying like, you know, medical director, medical review. Yeah, I think that makes sense. I think the other outcome possibly, I don’t know if we want to like capture like a medical director decision versus like the whole committee voted on.
Sarah-Dina Durand (20:08) Like what to do with the providers. So like for example, if, you know, we’re kind of onboarding someone and they just had a flag that happened recently or sorry, they had a flag that happened 10 years ago. What our review, the medical director can review that file and say that was so long ago. Everything’s kind of looks good now that was like over 10 years ago. So there’s no need to bring them to committee. And so the medical director can just decide to keep them on. But however, if that provider, if the action was more recent, we would bring it to, committee then would make a decision on what to do with the provider. So it wouldn’t be like, I don’t know if I don’t know if it makes sense to kind of capture like medical director decision versus like the committee voted on. Yeah, this person?
Kelly Chang (21:05) Yeah, that makes sense. So kind of to clarify that medical director committee. It sounds like in certain cases, it can just be kind of like a two step review where you review it, you review it, you hand it off to the medical director and then it’s decided. But sometimes then it’s you the medical director and the committee. So like three step, is that correct? Or it’s always like a two step kind of process?
Sarah-Dina Durand (21:31) That is correct. So most cases, it’s two. And then like in some cases, it’ll be like we have to discuss it at our like monthly meeting, okay? And.
Kelly Chang (21:45) that, yeah. And that decision to escalate to the committee would only happen from the medical director’s kind of decision making, right? Like would you ever decide I’m going to directly escalate it to the committee?
Sarah-Dina Durand (21:58) No, no, no. He would. Yeah. Okay. So if there’s an option for him to like say sent to committee for review or something like that. And then after the meeting then like I can go in and say like file reviewed at committee or I don’t know if you want to add all that. But, yeah.
Kelly Chang (22:21) This prototype, I didn’t build out necessarily the whole like what happened and how the committee would use it, but we just, yeah, I wanted to make sure it is like that, is that like second decision to then escalate to that third kind of reviewer. So yeah, that makes sense.
Sarah-Dina Durand (22:39) Yeah, I think it would make sense to have an option to say like a waiting committee review or something like that because if we’re reviewing a file at the beginning of the month, the meeting’s not till like the end of the month, I think it would be good to kind of have like a status where people know what’s going on with it.
Kelly Chang (23:00) Yeah, makes sense. And,
Yenny Zhang (23:03) Sarah, are you talking about like a monthly committee that meets like separate from the credentialing?
Sarah-Dina Durand (23:09) Yes. Yeah. So, this is a board of like providers that we have that kind of reviews… like cases that are a little bit more complex or like things that we’re like, we’re not sure about that. Let’s kind of discuss and vote on it.
Yenny Zhang (23:25) Yeah. Got it. Okay. And so you’ll get the results every month after, sorry after? Okay. Yeah. And you will take the results of that and kind of like update your tracking spreadsheet with like the final.
Sarah-Dina Durand (23:38) Outcome. Okay. And then draft any like letters. So, like if we’re suspending, I would draft a letter and say they’re suspended and, or if they’re staying on, we’ll tell them that they’re staying on in the letter, yeah.
Yenny Zhang (23:50) Got it.
Kelly Chang (23:51) Okay. And,
Yenny Zhang (23:52) do you store that letter within medallion at all? Or are you just sending it to the provider?
Sarah-Dina Durand (23:56) I do, I add it to the documents section in medallion and I don’t now that we’re talking about it, I don’t know if providers have access to view files where we add to their profile. Do they?
Collette Waddell (24:13) Yeah, they can see anything that’s uploaded to the document tab.
Sarah-Dina Durand (24:16) Oh, okay. Okay. That’s good to know.
Yenny Zhang (24:21) I’ll send feedback for.
Collette Waddell (24:23) That, yeah… Kelly, can I ask just for my just clarification? And maybe I’m thinking too far down the line when on that initial monitoring table where you have the three tabs, the… this needs review escalated result. So needs review. Is the kind of the idea here is that’s where our client admins like Sarah and her team would be going in and kind of reviewing what’s flagged, right? And then once it kind of gets reviewed and possibly moved into that escalated bucket if you will, is this where we like intend the like medical director for example, to be coming in and resolving this? Or is this where we anticipate, I guess it could vary based on customer and whether or not it’s like the admin just coming in here and like administratively recording what the, you know, was or if the idea is that the individual that needs to be reviewing it such as the medical director, is this where they’re… yeah.
Kelly Chang (25:34) Great question. We actually had a follow up question around that. So, Sarah, I know we had asked you around like how you like notify the medical director right now and it’s through email. And so when, you know, when we’re building like product, I think we want to assume that people will come in and like use this product. But obviously, you know, depending on customer how busy this role is, maybe they don’t want to log into medallion. So I’m curious like from your perspective, do you think that in spring’s kind of world of like the medical director, they would come into medallion to help or to use this like as a queue to like work through? Or do you think that wouldn’t be feasible? Maybe we can explore other options of like kind of what Colette is saying, like you would, then maybe you could export this to send it to the medical director and then come back and log or curious what you think that workflow could look like?
Sarah-Dina Durand (26:32) I, so when we received a report, I have to send out an email because there is also a quality team that kind of has to review. But more often than, not, it’s more so for like awareness to them and they’re not necessarily taking action on it. So I like the idea of having it all tracked in here. And so I would want the medical director to log their decision themselves. And then I can like add any supporting document from the email, whatever to the file. But I think it makes sense to speaking of, are we able to add attachment to the notes in this?
Kelly Chang (27:18) Yeah, that was exactly gonna be my next question. Is I’m curious what kind of attachments are you typically adding? If you do?
Sarah-Dina Durand (27:25) So just so I can capture like what was discussed in the email, like I just print out the whole thread and just, you know, put it in there just again to track everything and it can kind of be like you can kind of see what was said and why we decided what we decided on and it’s just kind of all right there. And it’s not me like copy and pasting what was said. So I just add stuff like that in any like outside documents. So like let’s say there was a license action. Oftentimes I’ll go into the state board and find the like court document and add it.
Kelly Chang (28:01) Got it. The.
Sarah-Dina Durand (28:02) Medical director can have everything that he might need to kind of make a decision. Got.
Kelly Chang (28:07) It. Okay. Is there ever a case where like the medical director comes in? Let’s say they’ve decided an outcome, and then maybe you review the file and then decide to add more information after the fact or is it just kind of a straight shot like from one person to the next? And you’re not needing to like re, add stuff back to it? I.
Sarah-Dina Durand (28:31) Think there might be cases where I do need to re, add. So let’s say the decision was made to like terminate. I would want to draft the letter and ideally, I would want to put that letter in that section so that wouldn’t happen until after the decision was made.
Kelly Chang (28:47) Yeah. Okay. So, it’s yeah, more of like a working kind of file? Yeah. Okay. That makes sense. And then really just quick question. Like when y’all, are, you know, I know you talked about medicare opt out, like possibly being a very fast, you know, action of like just needing to update it. Would you ever like want to do it at this top level of like just mark all as like reviewed or do you always want to kind of get into this? Like more detailed like provider views, see the primary source evidence and do it like one at a time?
Sarah-Dina Durand (29:22) So, I think one at a time would make sense because I have to, in order for me to update our internal system, I have to get the opt out end date and like add it to our Salesforce? Okay?
Kelly Chang (29:42) So, you, yeah.
Sarah-Dina Durand (29:42) I would need to see like the data. Okay.
Kelly Chang (29:47) Perfect. Cool. Yenny. I know we have a few more questions. I want to make sure like the ncqa compliance export, we fully understand. Do you want to get into that first before the other questions or?
Yenny Zhang (30:05) Yeah. So excuse me, I understand that it’s important for you all to be able to, you know, export a log of like all your review. And it sounds like in addition to just like adding notes, you might want to add like documentation and things like that… in terms of like getting audited, is it important for you to like have that also have that documentation in addition to like just raw text notes available when you’re going through an audit?
Sarah-Dina Durand (30:37) You know, I’m not Kurtz is the one who does, who deals with that. And so I’m not 100 percent sure, but I can definitely confirm, but I know like at a sort of like higher level, they kind of just look at like, you know, what was reviewed or if the action was reviewed and what the outcome was, and then if needed, you know, sometimes you’ll pull like specific files and dive into them like individually. So I think… I’m here. Hi, Lubna. Hi.
Kelly Chang (31:15) I can probably help answer. Could you repeat your?
Sarah-Dina Durand (31:19) Question? Sorry?
Yenny Zhang (31:21) Yeah. I was wondering what is like what information is sufficient for like an audit? For instance, because we were just talking about how it would be nice to be able to like add attachments after reviewing to, you know, sort of like supply the review with like any specific documentation.
Sarah-Dina Durand (31:40) And our.
Yenny Zhang (31:41) team has been thinking about like how we could export a CSV of like an audit trail of all of your review? My question, is it necessary to be able to like link whatever documents you uploaded or is just seeing like reviewed by the note?
Lubna Kaur (31:58) It’s just like they just want a log that shows reviewed by who reviewed it. The notes are not really that important for the monitoring log, but it does need to show the dates that it was reviewed. And if there was any action taken?
Yenny Zhang (32:13) Awesome. Kelly, do you mind if I share my screen to?
Kelly Chang (32:18) Just.
Yenny Zhang (32:19) go over like what a… CSV could look like, okay?
Yenny Zhang (32:28) All right. Can you see my screen? Yeah. Okay. So I know we’ve just discovered that like or just clarified that your workflow is mostly two step but sometimes three. So the first step being like the specialist review, a second step, maybe we escalate to medical director. A third, maybe we take it to committee. So this spreadsheet only captures, I think the specialist and the medical director, but the sort of what an idea of what could be like an export log, we have the provider name their npi, their last credit date, the source, the ongoing monitoring source that we checked. I think here what is missing too is like maybe we’d add columns for license data if it’s a license expiration.
Lubna Kaur (33:22) Let me.
Yenny Zhang (33:23) Just add that here because it’s not here right now… license data… or license expiration, monitoring… the date that this was flagged, the date that it was resolved by your team, the flag status, any action taken? Oops, this should say provider suspended… notes who was performed by, and then details of like who did the initial and the final review?
Lubna Kaur (33:57) Yeah, that would actually be perfect.
Yenny Zhang (34:00) Okay. Great. That’s good. Another question I had, is it important for you to see like all flags whether they’ve been reviewed or not? So for you to see like in an export, these are the flags. These are all the flags that were raised by medallion system and we want to understand like did you review all of them? Like is that a question that needs to be answered from an audit? I?
Lubna Kaur (34:24) Think so because just because of our network size, you know, it’s possible that we may have missed flags. So it’ll just be like a secondary check to make sure that we’ve reviewed everything?
Yenny Zhang (34:35) Right. Okay. Great. Thank you for confirming that. When.
Kelly Chang (34:40) exporting. Is there like a time frame that you need to select between?
Yenny Zhang (34:46) Or like.
Kelly Chang (34:48) I guess, yeah. Just curious how that works?
Lubna Kaur (34:51) Yeah. So usually, for an audit cycle, they audit for the past year, so we would need to kind of select those dates for the logs before we export, got it. Okay?
Yenny Zhang (35:05) Cool. And so that dates would be filtering on like all flags that were raised within this time range, right? Okay. Perfect. Cool. I think Kelly, do you mind if we go back? Do you have any more questions about the?
Kelly Chang (35:21) Export? Yeah. In this, in this, the final action would be like the outcome, right? That I had shared in the prototype?
Yenny Zhang (35:33) Yeah. I guess. So what’s missing right here is like any, the third step, like, if it was escalated to committee, is it important that we capture that too here? So like, yeah.
Kelly Chang (35:47) I guess the question is like for the ncqa audits, do they want to see the stages of like review or do they just care about that final outcome? They?
Lubna Kaur (35:56) Just care about the final outcome. So they wouldn’t okay. What stage it was in, but I think for us, it would be important to see that in an export.
Kelly Chang (36:05) Got it. Okay.
Yenny Zhang (36:11) Okay. So, yeah, I think it sounds like just with whatever review that is happening in platform, it would be important to be able to export that. Yep. Okay, great. All right, Haley, do you mind? Yeah, stepping back into the prototype? Yeah, sure.
Kelly Chang (36:31) Okay. Can you guys see this? Cool. Yeah. So I know we have a few more questions. Yenny, do you have the rest of the ones that we want to ask? Let me see. Yeah.
Yenny Zhang (36:48) I wanted to ask some, I think specific questions about just like the monitoring sources to make sure like we are covering everything that your team needs to demonstrate ncqa compliance. One thing that I noticed for spring is, I think we don’t do ongoing monitoring for you for medicaid exclusions. Is that correct?
Lubna Kaur (37:12) We shouldn’t be doing medicaid exclusions. Oh.
Yenny Zhang (37:14) We are, we are. Yeah. Oh, okay. Sorry, we might have missed that. Okay. So one thing that we do know that is a gap in our platform is that we don’t have the medicaid exclusions, monitoring. Like in medallion, we generate the streamline verify monthly reports. So part of this also involves bringing that into platform and being able to monitor it in platform, wanted to confirm that like this is something that would like make a complete ongoing monitoring experience for, yeah.
Lubna Kaur (37:46) I actually didn’t know it was external to medallion. So it would be great to see that data come in through here and for us to review.
Yenny Zhang (37:54) Awesome. Okay, great. And let’s see. Yeah, I had some more questions about, I think the committee like the final committee review step. So I think right now it sounds like Sarah would be coming in here and doing the initial review potentially escalating to a medical director, your medical director could come here and document their outcome here. So they would be seeing the screen and seeing something like provider suspended provider terminated. They could also escalate to committee or refer to committee, then it would be Sarah coming in here, basically documenting whatever committee decision is made. Is that correct?
Lubna Kaur (38:42) Yeah. Okay.
Yenny Zhang (38:48) Sorry. Excuse me. Okay, great. My next question is just about what happens when a provider is clear after being reviewed, does your team currently keep track of a change log? Say you’ve reviewed that? One of your providers has opted out of medicare medallion monitors this monthly, the next month. We find that they’re not on the medicare opt out list anymore. Is your team actively looking for that right now? Because I don’t believe our platform will notify you if the flag changes payr?
Lubna Kaur (39:33) Do you want to chime in here?
Sarah-Dina Durand (39:34) So, the way that we monitor that is through the opt out end date. So my sheet has the opt out end date. So I’ll go in and filter it and see if there was anyone that has passed recently, and I’ll go in and like see if they’re still on the list, I see or if they’ve been removed. So they’re not actively opted out anymore.
Kelly Chang (40:02) Yeah. So I guess if we were to, because I’m hoping a lot of the review that we’re building will sort of be able to enable you to not use kind of that spreadsheet tracking, right? In the case where if we were to remove that spreadsheet tracking, you would want to be able to have a way to basically understand if that end date has passed.
Sarah-Dina Durand (40:28) Yeah. So, yeah, because oftentimes providers will say they want to opt back in and then I’ll tell them, you know, to let us know because there’s.
Lubna Kaur (40:37) no.
Sarah-Dina Durand (40:38) Way to kind of track that in the system unless I just do the manual, like look up myself and see if they were still on the list or not?
Kelly Chang (40:47) Yeah. Okay.
Yenny Zhang (40:49) But,
Sarah-Dina Durand (40:50) it would be good to have like… that change captured.
Kelly Chang (40:58) Yeah. Is that change needed to be reported to ncqa? Like is that captured in any sort of audit right now?
Sarah-Dina Durand (41:11) I’m not sure.
Lubna Kaur (41:13) Sorry, is what change needing to be reported to ncqa?
Kelly Chang (41:17) Like a scenario where?
Yenny Zhang (41:19) Like.
Kelly Chang (41:20) For example, Rachel, has we flagged that medicare opt out had happened and that goes into the export because y’all, you know, updated this, but then let’s say we’ve passed. And so now Rachel’s back and opted in?
Sarah-Dina Durand (41:37) Like it’s not, no, that.
Lubna Kaur (41:39) Doesn’t need to be reported to ncqa. Yeah, that’s just more like payor regulation. So, if there’s someone who’s opted out, we can’t have a medicare member, see that particular provider. So it’s not related to ncqa. It’s more like payor specific. Okay. Got it.
Yenny Zhang (41:59) And Sarah, so you said you’re tracking out the like end dates of these exclusions or sanctions? Is that in your off platform tracking sheet or like where are you tracking that?
Sarah-Dina Durand (42:12) Yeah, off platform tracking?
Yenny Zhang (42:14) Okay. That helps. I had a question. So when sometimes you might, you know, take action like terminating a provider suspending a provider? How does that, how do those actions factor into like the provider status within medallion? Like are you doing anything… at the provider level in medallion to sort of reflect that other than adding notes?
Sarah-Dina Durand (42:45) For opt out or just.
Yenny Zhang (42:47) For any ongoing monitoring flag? Like think of this as like a monitoring status like.
Sarah-Dina Durand (42:56) I don’t think there’s a way for me to like action on anything right now, right? Is that wait, I’m sorry. Yeah.
Yenny Zhang (43:04) Yeah. Are you deactivating the provider in medallion at all? Or? I don’t.
Sarah-Dina Durand (43:09) know, if that’s what, yeah. So if that’s what’s being done, yes, they’ll need to be deactivated in medallion. Yes… yes, we do.
Yenny Zhang (43:25) Okay. Or terminate. I think you can set termination dates in medallion too. I don’t.
Sarah-Dina Durand (43:38) I don’t use that feature. So I’m not sure if, yeah, yeah.
Kelly Chang (43:43) I guess maybe the kind of bigger question is like, how are you using the provider’s like directory? And how do you have like an internal kind of provider directory management system as well that you’re trying to mirror? Or is medallion like the primary kind of directory you’re using to manage statuses and stuff like that. So.
Sarah-Dina Durand (44:05) Statuses are primarily through our Salesforce platform and our internal provider like directory practice platform. Yeah. Okay.
Kelly Chang (44:17) Is there a, do you, are you using the medallion provider’s directory for anything specific, if you do have that Salesforce kind of internal system?
Sarah-Dina Durand (44:30) I don’t.
Lubna Kaur (44:31) believe we, are, we do have an API connection. So, as our providers, you know, their information might change or if their statuses change, it should be transferred back and forth between Salesforce and medallion?
Yenny Zhang (44:46) Okay. But.
Lubna Kaur (44:47) Outside of that, we’re not really using the provider directory for really anything else. Yeah. Okay.
Kelly Chang (44:52) Yeah, that’s helpful. Yeah, I think Yenny, that kind of answers the question of like it sounds like they’re tracking it more internally. And then we just need to mirror that somehow in medallion.
Yenny Zhang (45:02) Yeah. Got it. All right. That’s very helpful. Next. I had some questions about just like, if we’ve monitored a provider and we’ve say they were like flagged for, I don’t know Sam, maybe. Okay, actually npdb there was like something on their npdb report. Your team had reviewed it. It had been escalated and resolved, say that provider comes in needs to be credentialed, like the next month? How do you… and then for that provider’s next credentialing, are you taking information from the ongoing monitoring work that your team has done? And do you bring that into your credentialing process? Like specifically that credentialing committee versus?
Sarah-Dina Durand (45:55) Like the,
Yenny Zhang (45:56) ongoing monitoring committee?
Lubna Kaur (45:59) Can you say that one more time? Are you talking about re, credentialing? Yeah.
Yenny Zhang (46:04) Say a provider, yeah, is getting re, credentialed like two months ago, you found some ongoing monitoring flags and they’re reviewed escalated and closed out. Is that information like the historical information from your ongoing monitoring review brought into that provider’s? Re, credentialing process? Yes. Or is it considered? Yeah.
Lubna Kaur (46:23) So, we would review any action that provider might have had in ongoing monitoring during their cred cycle, and then review that it’s either been addressed or cleared out before we do the re, cred?
Yenny Zhang (46:36) Got it. Okay. And that obviously that process isn’t supported in medallion right now. Is that something that you produce at the time of committee? Like in addition to seeing the cred file, like, you might have a bunch of documents, you have the cred file that medallion produced. And then maybe like your team’s ongoing monitoring review, yeah.
Lubna Kaur (46:57) It would be like ongoing monitoring. And then we also would review complaints and adverse events that we house outside of the platform right now, got.
Yenny Zhang (47:05) It. Okay. Thank you. Right. Any, any other questions from you, Kelly? No?
Kelly Chang (47:18) I think I, I’ve got my answer or question answered awesome.
Yenny Zhang (47:23) I guess Lou, did you want to see the full end to end workflow? I know you jumped in, you don’t.
Lubna Kaur (47:30) have to review, you can send me the recording and I can review it. So I don’t take up everyone else’s time and be repetitive.
Sarah-Dina Durand (47:37) Okay.
Yenny Zhang (47:37) Thank you. Let’s see. I guess one thing that I want to understand too is like, for, so we’re building this out, we showed you like an example of a CSV export, for the entire ongoing monitoring experience and for you to remain ncqa compliant, we’ll be adding this like audit trail export. It’s also important for, you know, medallion to demonstrate that we’ve been monitoring like every single month, things like that. So, is this CSV export that we just showed and a combination of the current analytics dashboard export sufficient to demonstrate compliance with CR? V? Yes. Okay. Awesome. Thank you. That’s our number one priority. So, yeah.
Lubna Kaur (48:27) Because your accreditation survey is coming up again this year too, right? So.
Yenny Zhang (48:31) Yeah, yeah. Okay. All right. If that’s the case, then I, yeah, I think, I’m good, awesome.
Lubna Kaur (48:42) In terms of timeline for when this might be like V1 live, what are you guys thinking on your end?
Yenny Zhang (48:52) With the way our roadmap is planned, I believe we’re planning to start development on this beginning of may. So like engineering development. Yeah. And we’d like to continue to partner with you to like continue to test things out. So, I… yeah, we’ll try to coordinate on our end. What makes the most sense for like how to loop you into it, initial testing. Like once we’ve actually like built things out, but with that, I’m assuming that’s something you, your team would be interested in. Yeah.
Lubna Kaur (49:25) Absolutely. Great.
Yenny Zhang (49:28) So, yeah, this is our priority, to work on this quarter. So I’ll definitely continue to hear from us. Great.
Lubna Kaur (49:38) To know. Thank you. Yay. Awesome.
Collette Waddell (49:44) Does anybody have any other questions or anything?
Lubna Kaur (49:49) I don’t think so. If you wouldn’t mind just sharing the recording just so I can review the initial demo that would be helpful. But Sarah, do you have anything on your end?
Yenny Zhang (49:58) No, this is very amazing to see. So.
Collette Waddell (50:01) Yeah, this was nice job, Kelly and Yenny. Thank you for this. This was, this was pretty cool.
Lubna Kaur (50:08) So much, this really helps us feel a lot better about this entire process. So really appreciate that.
Collette Waddell (50:13) Yeah, yeah, this is gonna be huge. Yeah, yeah.
Yenny Zhang (50:17) We’re really excited. I appreciate you taking the time to answer our questions today. All right?
Lubna Kaur (50:24) Well, you guys have a great weekend and we’ll stay in touch. Yeah.
Collette Waddell (50:29) Sounds good. Thanks. Everybody appreciate it. Bye.