Transcript
Seth Weidle (00:00) hi. Can you hear me?
Hamada Z (00:02) I can. How are you doing?
Seth Weidle (00:04) Hi, I’m doing well. How are you?
Hamada Z (00:06) Good, Seth. How are you doing?
Seth Weidle (00:08) I’m looking forward to talking today. I appreciate you hopping on. I have us down for 15 minutes. Is that time framework for you? Do you have any hard stops?
Hamada Z (00:16) A bit, but we’ll blitz through it. You’ll see my talking speed is at a very high clip. So I will get through a lot of information very quickly.
Seth Weidle (00:26) Awesome. Yeah.
Hamada Z (00:27) If you’re good with that, then we’ll.
Seth Weidle (00:30) absolutely. The whole purpose of this first call is just to really lay it all out there. Understand what it is you’re looking for, what brought you to check out a tool like medallium? I’ll share anything that you would like to ask about. And then if it makes sense, and we’re in alignment for next steps, that’ll be with one of our product experts who will do much more deeper discussion with a lot more time on the calendar for you. So with that, I’ll turn it over to you. I just want to share your role and some of the things that kind of sparked this outreach for a tool like medallium.
Hamada Z (01:01) awesome. So I’m head of legal. And what I’m doing is I am trying to get our technology company to be credentialed… with a number of payers in different states so that we can eventually become a healthcare or a virtual health provider in that state. So, right now, we worked with a credentialing company in that essentially helped us start the process, kickstart the process in California. And in Michigan, we went through about five payers. And then a couple of things happened. One, it became a very onerous process. In terms of our technology. We were getting constant email updates being told, hey, you need to sign this document. Hey, you got to sign this one. This one is going to be in a DocuSign. This one’s going to be in a PDF. This one needs a wet signature. Oh, they need this one. Oh, you only have one month to finalize this one and it became a goddamn nightmare to kind of manage. Not only that. But we had, our CEO… was the one who was signing on behalf of our company, who’s also a medical director of the entity. And then we had to have another provider who was more, who was able because of the taxonomy to provide the service that we are offering, which is behavioral health consulting. Otherwise, our medical director, our CEO is a radiologist, so you couldn’t do that. You couldn’t sign on behalf of that as the provider. So, we had a psychiatric consultant who was doing that because we operate under the collaborative care model which requires a psychiatric consultant, PCP behavioral health coach patient in the middle. Long story short, that psychiatric consultant was also getting overwhelmed with all these documents flying everywhere. It wasn’t very, it wasn’t managed very well. And the technology that we needed to kind of manage it was just not there. So I couldn’t go to a specific platform and see where are we with blue cross in California? What has been submitted? What has been returned? What do they require? When is the expiration date? Then on top of all that, the maintenance. So now that we are qualified and we can actually operate well, we need someone to maintain it. And that’s almost like I need an entity who can oversee that because I personally cannot juggle all of that with different payers, different providers in the different states. So I then went out, interviewed a bunch of credentialing companies that we can shift away from the one we were working with, found a couple. And then the other co founder of the company messaged me and said, hey, we need to make sure that we’ve done all our diligence. We are a y combinator company, y combinator companies tend to be very favorable to other y combinator companies. So therefore I want to find out there are two other companies out there that I want you to quickly research. One being you, one being another company that’s also a y combinator company. And so what I want to find out from you is can you guys a, work in multiple states, B, work with one or two providers, which is what we have. Now, one is a type ii mpi. One is a type I mpi. We eventually will have probably another provider who’ll be a type I mpi.
Hamada Z (04:13) We have about five outstanding contracts in California, five in Michigan. Plus we need to maintain the existing five contracts in Michigan and the existing five contracts in California, and then pretty much use this new company, credentialing company to get into Texas, which is where we plan to go next. And then probably after that, we’ll be in, I don’t know, North Carolina and then Arkansas, and then Florida and on in different states. We want to grow with someone. So we need maintenance. We need credentialing and we need guidance. Somebody can come out and say to us. Hey, you guys want to do credentialing in Texas with medicare and just fyi, the cpom of Texas requires that you have a physical address, so that within the first days they’re going to do a flyby.
Hamada Z (05:04) Want to see the physical address? Want to see your name on the door, want to see the operating hours, and those should actually align with the hours that you put on your medicare form, just fyi. So we need that kind of little tidbit so that we can really be successful in this process. And then obviously, it has to make sense financially for us as well. So there you have it.
Seth Weidle (05:23) Love it.
Hamada Z (05:24) Appreciate it, you.
Seth Weidle (05:26) Weren’t lying, you’re running at two times speed, everybody else seems to be running at one X. So let me just talk back and say back what I heard. So the goal really is to move from I’m guessing all of this is landing in email inboxes, maybe a spreadsheet here or there that somebody is trying to keep track of everything that’s just becoming insane with five payers in California, five payers in Michigan and you want to move into Texas? You currently, did I hear it correctly? You currently have two providers? Are they, are those two providers providing services for both Cali or is it like one is in California? One’s in Michigan?
Hamada Z (06:06) No, the provider mpi, one type one provider is for both and will be for Texas. We’re using his license to make those contracts. But we are also having our mpi two, which is our company. Mederva medical is the one that’s signing the contract, and that is owned by a medical director, which is as required who is also the CEO of mederva medical. And mederva health, mederva medical being the company that has the mpi two. And they’re the ones who are going to be contracting with the payer. And then the mpi, one of the providers, the one who’s going to actually be executing. So we need to include them in those contracts as well for the Texas.
Seth Weidle (06:53) Gotcha. Okay. And then the goal is to move into Texas with I’m assuming more payers in Texas and more providers. Do you have an idea of like is there a set number of new hires within the next six months that you’re shooting for?
Hamada Z (07:10) For providers?
Seth Weidle (07:11) Providers?
Hamada Z (07:13) Max, I think one.
Seth Weidle (07:14) Okay. So.
Hamada Z (07:16) It’ll be two providers. Well, it’ll be three providers in Texas, the mpi one two for the company. Obviously, I had to, also, I had to foreign qualify the mso, but then I also created a new Texas entity in Texas for mederva medical because we needed it as a pa. So that company has its own, has the medical director, which is the company founder that’s going to be one that we have to credential there. And then we have one provider for sure, which is the one that we’ve been working with is also licensed in Texas. And then we probably need a PCP that we need to also credential that will be in Texas as well so that we can really truly operate as a virtual. So I’d say within the next six months, realistically, we’ll have three providers, two type ones, one type two. And then probably six months after that, that’s when we’re going to probably balloon and then start going from like three providers to, I don’t know five providers or 10 providers or more. Gotcha.
Seth Weidle (08:16) Okay. So the goal, so once that sounds like once you land in Texas, that’s when things you’re hoping things will really expand and.
Hamada Z (08:24) Take off, yeah, Texas and probably the state after that, because the truth of the matter is we haven’t really tested our virtual health practice yet. We’re just trying to get the payers on board so that when we fire up the ads and a patient comes and says, I’m with blue cross, we’re not saying sorry, we can’t work with you, right? We can actually start working with them immediately.
Seth Weidle (08:43) Yeah, understood makes sense. So, and then the services that you’re interested in, obviously multi state licensing is going to be one of them as you expand network, cvo, credentialing. And the primary source for credentialing is that something that you’ve been handling? I.
Hamada Z (09:02) Don’t think, I think for the two individuals that they have the cahq or whatever it’s called that’s all.
Seth Weidle (09:08) Up to date caqh. Yep.
Hamada Z (09:09) Caqh. So that’s all up to date. The PSV, I don’t think is something that we need for these two providers, but we’ll probably need it for a third provider.
Hamada Z (09:17) Once we get them on board. I think for me, the most important thing I’m looking for is Seth calls me up and says, hey, Texas, what are you guys thinking? I’m gonna tell you here are the 10 payers we’re thinking of you’re. Gonna be like, look, we know Texas inside out and we think you guys are missing these two payers. The other two that you guys have on your list, they’re not gonna be a great fit and, or they’d probably be close panel and it’s gonna be a nightmare. It’s not worth it. Let’s go with these two. And this is why, okay, great. Let’s go with it. Which ones are we gonna start with?
Hamada Z (09:45) These five payers? Then move to these five payers. And then you guys are essentially executing starting the conversations with these guys negotiating up to a point we’re realistic. We’re a tiny company. So they’re probably not gonna allow us to negotiate hard. But probably in the second year we’d expect that to happen and then move from there to say, okay, hamada, where’s your Texas physical location here’s? The address, and then basically going through there. And then I have a portal that I can see everything happening. Yeah, yeah.
Seth Weidle (10:13) The ongoing monitoring, pay your enrollment. Okay? The next question that I have, and this one kind of is one of the make or breaks. So in your world, are you looking for us to be an outsource or are you looking for a software where you guys still maintain the outcomes?
Hamada Z (10:31) No, I don’t want to do anything to do with negotiating or credentialing. If I wanted that, I’d go to like 50 other companies that are offering this for like peanuts gotcha. We need someone who’s actually going in there, securing these credentialing companies for us until we reach a, maybe there’s a point where you’re like hamada, it’s probably a good time to consider hiring in house and we have someone who’s seen you guys do it 10 times and knows it inside out. And then maybe we would just use the software with you guys and then just have our team doing it in house the.
Seth Weidle (11:00) Reason I ask that question is we don’t offer a software. We don’t offer a self serve. We only offer outsourcing. Now, the other thing that I heard you say a couple times was negotiating, we do not negotiate on your behalf. We gather all the information, get you enrolled with payers. But when it actually comes down to contract negotiations, we leave that up to you. We equip you with as much information as possible to assist you, but we do not do contract negotiations. Is that a deal breaker?
Hamada Z (11:29) I don’t know if it is to be honest, Seth, it’s like give me something I have never had to deal with.
Hamada Z (11:34) In my mind, it just seems asinine that a tiny company would actually go toe to toe with a payer, like I want more favorable rates. But if that was to happen, and from what I discussed with other credentialing companies, it wouldn’t happen for the first year. We would want to see what our billables come back at. And they want to see what those are coming back at, how many claims are coming through, how successful is it, then they may be more malleable at which point, like you said, we would have someone like you provide us with the tools the other companies do negotiate on our behalf.
Hamada Z (12:06) Some of them are wild. They were like if we negotiate and we get you a more favorable rate, we take two percent of the delta. I was like, holy crap. But in the grand scheme of things, maybe that works because they’re going to save us 50,000 dollars that we would be making. And if they take two percent, that’s very fair if they got to that point. But again, no harm. No foul. Let’s cross that bridge when we get there, yeah.
Seth Weidle (12:32) And then the last thing before we end here is with you guys being at the size you’re at now generally medallion looks to work with, we work best with companies that are in the 20 plus providers. The reason being is our minimum contract value. So our base entry level is around 50,000 dollars annually. So I want to address that with you now seeing as how small you guys are with the number of providers you have, and make sure that is a financially understandable thing before moving on to the next conversation. When you hear, you know, our base contract value being 50,000 dollars. What does that look like to you at the startup phase that you’re in?
Hamada Z (13:21) So when you say 50,000 again, the way that credentialing… works is a very convoluted process because if you’re sending 10 payers, two providers each in state, Texas, and now we are in April and we wrap that up, let’s say by August and then synchronistically at the same time. And in parallel, we told you we want to start expanding into North Carolina. So now you start that 10 process there and get those applications out the door and you’re still trying to finalize those applications in California and Michigan. And then you’re still maintaining the new ones that you know, what does that look like financially? And then we tell you, no, no, just focus on Texas in 20 26, up to Q4, then we’ll approach it. What does that look like? Because it’s all about the numbers. If I tell you 10 states, 10 payers, two providers that’s a wildly different number than is one state, 10 providers, 10 payers. You see what I’m saying? Yep. So how does that work? So?
Seth Weidle (14:30) It does come down to the payer enrollment is the big one. So you currently have 10 payer enrolled. You currently have 10 enrollment or payers that you’re enrolled with now, correct? And then, so if you were to say your goal is to get to five more in.
Hamada Z (14:49) Michigan and California.
Seth Weidle (14:50) Michigan and California. So that would be a total of 20 payers. So now you’re now with just those two existing providers, you’re above the threshold of the 50,000 dollar minimum.
Hamada Z (15:02) How much is it for each provider?
Seth Weidle (15:05) So our rough estimate has payer enrollments with new providers at two… 150 per provider. And so if you’re doing that across 20 payers, you’re looking at 60,000 for… the payer enrollment process. So two.
Hamada Z (15:29) 50 per provider per payer. So that’s 500, right? That’s 500 dollars per payer. Yes, multiplied by 10 is 5,000 dollars for that state’s 10 payers?
Seth Weidle (15:45) Yeah. So I have here 20 existing enrollment payers? So if you were to, so that’s taking into consideration the upcoming five more added in California, five more added in Michigan for a total of 20 payers?
Hamada Z (15:59) Yeah. So if it’s 20 payers times two providers, 20 times 50 at 500 is… what is that? I can’t even do that? 20 times? It’s two times 500,000 that’s 10,000 dollars? Yeah. Okay. So then, sorry, I’m.
Seth Weidle (16:18) sorry, I had in with plans to add new providers.
Hamada Z (16:23) Yeah. So then if that was the case, we wouldn’t come anywhere near 50,000 because even, that would be 10, basically the way you guys are pricing, it is for the two providers that we have, which is the company and the one individual, it’s 5,000 per state, correct? And we are certainly not doing 10 states in 20 in one year, right? Not at this stage. So we would only be at maybe three states. So at most, it would be 15 K.
Seth Weidle (16:50) Yes.
Hamada Z (16:51) Okay. So at 15 K, what happens there? Then you guys are like, sorry, no dice. We have to hit 50,000.
Seth Weidle (16:57) That would be, yes, that would be for us. That would be one of those situations where we’re not going to, it wouldn’t make sense on our part business wise to provide services simply because with all of the background work we would be doing, it wouldn’t be profitable. There wouldn’t be a return on value on our part. Okay? So that’s why, and that’s one of those things where that growth expectation when that comes in, it’s hard to quantify. And so we try to go off what we currently have. And so at this, it seems like at this current moment, there’s just unfortunately just not enough… providers only having two providers even with adding a bunch more payer enrollments.
Hamada Z (17:45) Right. Because from your perspective, the sauce comes in not the number of payers but.
Seth Weidle (17:50) The number of providers we’re putting into these enrollments, because.
Hamada Z (17:54) Yeah, no crazy company is going to come at you and say, give me 50 payers because there’s a finite number, right? But there’s an infinite number of providers. Almost. I got you. So once we get to like four providers or eight providers, then it suddenly hits your 50,000 ceiling.
Seth Weidle (18:10) Yeah. When you get to, if you’re looking at 20, like 20 payers is a good number. When you get to 10 providers, you’re at the 50,000?
Hamada Z (18:19) Exactly. That’s exactly right? And.
Seth Weidle (18:21) Honestly, a lot of the people we work with don’t like 20 is pretty high compared to a lot of the, even some of the bigger organizations. Now, some of them are just in one state. So that does kind of throw that wrench in the system being in multiple states. But yeah, it’s that balance of more payers. You can have fewer providers. Yeah. But it does need to hit that threshold. And that 10 provider mark is where we’re really going to be able to provide you the most bang for your buck as well as make it reasonable on our end as a business to continue.
Hamada Z (18:54) Gotcha. And just so that I know, so I can return this conversation back in terms of a y combinator deal, what do you guys provide y combinator companies?
Seth Weidle (19:04) That’s a great question. I honestly don’t know. I can reach out to my manager and find out some more information and follow up with an email there. Honestly, I have no idea. So I’ll have to gather that piece of information before.
Hamada Z (19:19) We close the door for this conversation, current stage of the company. Let’s put it that way. Let’s find out what the yc deal is. So then I could bake that into the overall calculation because if suddenly the, I mean again, if they’re like for yc, we don’t have a 50 minimum. We just ask you, we just work together. Then now the conversation’s open and we’re off to the races. If they’re like, no, it’s still going to be 50. But instead for y combinator, it’s 25 for 30 that’s still going to be slightly steep for where we are and then get there.
Hamada Z (19:55) So let’s figure that out, at least get back in touch with me. So this is not a wasted conversation. But more importantly, like we said, if we get to that stage, obviously, we love working with yc companies as a yc company, we would love to continue working with you when we get to that 10 provider point.
Hamada Z (20:10) But maybe there’s still a way to a path forward. If your guys come back and say, yeah, this is what we need.
Seth Weidle (20:16) To do. I will look into that as soon as we hop off here and hopefully get you more information with that throughout the week.
Hamada Z (20:24) Sounds great. I appreciate your time, sir. Thank you so much. Thank.
Seth Weidle (20:26) You hamada. Did I say that right?
Hamada Z (20:28) You said it absolutely flawlessly Seth.
Seth Weidle (20:30) All right, wonderful. I appreciate it. You have a great day take.
Hamada Z (20:34) Care. Bye, bye bye.