Transcript
Helder Molina (00:00) I’m going to be paying two providers, right? I mean, your company and them?
Josh Brunell (00:04) Are you paying them on a per unit kind of basis? Like, hey, you complete this work for us or do you have like an annual agreement with them?
Helder Molina (00:13) I’ve got a monthly agreement with them. Yeah.
Josh Brunell (00:15) Monthly. Okay. Yeah. We would give you, we would yeah as we continue the conversation within the next call or two, I’ll loop in our head of technical solutions and they will build out a project plan with you so you can have like exact dates in mind of when certain functions that they’re doing will roll off and officially go live with medallion.
Helder Molina (00:41) Perfect. Cool. But.
Josh Brunell (00:45) Going back to like more high level business, I would say like challenges today, like what’s the primary reason? I know we, this is what David shared, but I’d love to hear from you like primary reason you’re moving away from your current vendor?
Helder Molina (00:58) I think my current vendor is, has done fantastic. But we’re growing too fast for her. And I think that is my biggest challenge. I mean, we are currently doing… I will say average eight new acquisitions a year and every acquisition that we do, we gotta, reconcile all the agreements with insurance. What that means? Let’s say that I have… in this bulk already that all practices I got blue cross blue shield, right?
Helder Molina (01:34) But I have in this new acquisition of practice, I have one company that I was not having it before because couple of reasons because maybe it was a local insurance that we didn’t have before or it’s an insurance that is based in zip code. But what that means is I wanna go back and add it to my current network, right? Because we work under our network. So technically is to update all the facilities in that contract and make sure that contract is part of us, the whole nine yard and before… was only four providers and the number keep going up, right? And keep up with that. I mean, I think it’s going out of hands. So like I was sharing David, I mean, it happened recently we bought, we created a practice from scratch insurance, Texas. So we opened the doors shares. Texas was already part added to our contract with blue cross blue shield. I will sell like a week after we opened after blue cross blue shield has set my shares location. You know, then remove our main location from 20 years ago. So nobody find out until we got all the decline because the location was not part of our contract. Now, I don’t blame the credentialing company by itself. We know the insurance, they have a disaster inside of their admin side, but I want somebody to be able to oversee that and make sure that all my locations are there. And it’s not about the volume of the provider. I think it’s the volume of locations that is my biggest issue.
Josh Brunell (03:12) Got it. And so you are enrolling each one of your locations with the is, would you say, like how many health plans, how many payers per location?
Helder Molina (03:23) All the contracts, so.
Josh Brunell (03:25) It’s, all 120. Okay. You’re you’re primarily just in Texas, correct? Or are you?
Helder Molina (03:33) Just, the majority is in Texas. We are in North Carolina and we are right now because we already purchased a facility in, Tulsa, Oklahoma, got it.
Josh Brunell (03:47) That’s awesome congrats on all the growth. It’s a good problem to have on the enrol on the facility side. So, yes, we could absolutely help support with facility level enrollments. We could also help as well with what we call linkages between those and your group contracts. And from a process standpoint, one thing that is going to be changed and unique is like you probably have like you said team was doing a fantastic job up until you hit this point of scale.
Josh Brunell (04:17) But payr, when you’re working with 120 different payers that have 120 different processes, it gets really difficult to track. I would say like our biggest differentiator and why organisations partner with us is because we map out and do the research on your behalf. So you never have to worry about it and map that to the back end of medallion platform. So we have over 900, I think over a 1,000 payers processes mapped out on the back end of medallion anytime we get a new payor that we’re doing an enrolment with. For the first time, we have a research team that goes out and essentially maps out. Hey, what is the perfect application? Like, what does the perfect application look like? What’s all the pieces of data and information we need to get this enrolment application out the door and get either the provider or the enrolment or the facility enrolled with the health plan. So we do that work for you. And we have a whole dedicated team just doing that and then building automation in our platform. So that all your team is essentially doing is going into the platform saying, hey, having this provider start, I need them enrolled. You could do a bulk all 120 of my payers hit select and then our automation takes it. From there, we could also set up auto renewals as well or revalidations for those. Same goes for requesting, hey, I need to get this, you know, a new group contract or I need to get this new facility enrolled as you’re growing and expanding. So it’s much more of like, hey, you’re owning the strategy and tracking the process, but all the manual mundane work that is probably very hard for that one individual to keep up with from that credentialing vendor. We are taking that and we’re managing it end to end with automation first. And then we have humans in the loop to make sure that, hey, all this work is getting done thoroughly and effectively as well. So, yeah. So that’s really like the value driver and the difference between us and maybe some other vendors that you might be considering. Like, we know a lot of organizations in your position kind of take one of these approaches, right? It’s like, hey, we’ve hit scale. Our legacy cvo doesn’t work. Should we consider hiring and scaling this in house? Should we maybe hire a bpo of some sort? We know that these solutions historically like have been like the kind of stopgap. But like the way we think about this is like end to end, we want to be a partner with you. That allows you to scale from 24 providers to 100 plus every state, you know, be able to support any number of payers. So, I guess that leads me to my next question like how would you, I guess measure and say you ultimately select a partner? Like what are the big things that you would like to see change as far as like outcomes for the business?
Helder Molina (07:13) During all these years because we keep growing and growing. What I have not seen is a formal process to renegotiate the contracts. And I think I will call that success if I’m able to see an improvement rate right through renegotiating the contracts. And the reason behind is very easy, right? I mean, it’s not the same one provider seeing let’s say 300 appointments a month than bringing 10,000 appointments a month, right? So, I think the volume that we bring and the care that we bring to our patients, I think that is something that I can consider success… you know, like we buy practices pretty much three every quarter at least or at least two every quarter.
Helder Molina (08:07) So, my current provider of credentialing, I mean, is busy like, you know, registering all these providers and all the insurance and making sure they add the location to the contract. But I don’t see a valuable process for renegotiating the rate.
Josh Brunell (08:24) Understood. And here, I’m just going to make sure I’m very clear about this too, like we would lend… we would help assist with that outcome. And of course, getting those newly acquired clinics onto your contracts faster. And then by doing so, we’re going to help you have better negotiation power because of course, your practice is going to be larger and we know that the payers will, you know, you’ll have more negotiating power when you have, you know, more patients, you’re reaching more providers that you’re enrolling. The one thing that I do just want to be clear is like while we support all these different things on the screen like we’ll help you get your providers enrolled, we can help with delegated credentialing as well, which is essentially, I don’t know if you’re I guess I should ask this earlier. Is that something that you’re considering or probably… not at this stage? But in the future… delegated? Credentialing?
Helder Molina (09:33) Yeah. I mean, I told David everything depends on, you know, how it’s engaged and how we’re working together because it is part of the process for sure. So, and I don’t want to have two companies that’s for sure. So I think it will be smart to delegate it.
Josh Brunell (09:48) Yeah. And when I say, sorry, the way when we say delegated credentialing, so there’s the notion… of what you’re doing today, direct provider enrollments, where you’re where you are submitting an enrollment to the payer and then waiting for them to essentially review that application and then say, yep this person is now in network and reach par status, so that’s like the standard process you’re probably following today. Is that right?
Helder Molina (10:17) Yes, yeah.
Josh Brunell (10:19) With the delegated credentialing so that’s something that some payers have definitely the national payers all have but some you know regional as well. But essentially what it allows you to do is instead of submitting direct enrollments through a payer portal and they’re waiting for them, you can actually submit, you credential them and then are able, your agreement allows you to backdate essentially. So you could say, hey, I’m going to credential them to ncqa standards and do like essentially a primary source verification on their behalf. And then you’re taking the onus away from the insurer to actually essentially review that application and say, yep this person is, you know, has the credentials to be able to accept and be added to the network. It essentially takes the process from what could probably be taking anywhere from 60 to 120 days to get them through the provider through that lifecycle down to just like three days with medallion. So you’d be able to basically hire someone, and within three days, you can actually have them start seeing patients and then backdate effectively with that contract. Now, I’m sure that’s that might be, a new concept to you. And so I could share some information regarding like why that obviously, of course is valuable. It’s faster time to revenue, for your business. But the process to get that established there’s typically some specific payroll requirements that they have in order to set up that type of agreement. So one other thing to consider with, your goals you set out, hey, I want to improve and… have, you know, I want to negotiate rates and get better rate reimbursements. Delegated credentialing should be something as well that maybe you have on your radar because that’s another way to help drive or accelerate revenue. It’s not obviously getting better rates but it accelerates the process to get paid out faster which helps you grow faster. So one other thing to keep in mind.
Helder Molina (12:22) And you guys charge by percentage of how that service? Because now, I mean, I just want to understand if it’s part of the package or is an extra service? Oh no.
Josh Brunell (12:31) We wouldn’t have, no, no, we would not have that in scope until that is that’s something you have to, you have to set those agreement up with your payers. And so we could help you do that. But no, it’s not that’s not something we charge for. Let me, let me just ask though. So the 24 providers you have, you’re enrolling them in 120 health plans, and then you’re keeping up with those renewals or revalidations as well for those. And then you had, and then you had sorry, how many facilities you had mentioned at the start?
Helder Molina (13:04) We got right now, we got 30 locations.
Josh Brunell (13:07) 30 locations, okay? And, and… you are fully outsourcing this today. That one credentialing vendor. You don’t have any in house team members that are keeping up with, the overflow we.
Helder Molina (13:20) Don’t have, no, we don’t have nobody internally.
Josh Brunell (13:23) Okay. Yeah. What, what I can do, and I’m sure this is what you’re thinking is like, hey, how much is all this going to cost with those numbers? I could help put together a proposal question for you. The current vendor that’s doing this today, I’m sure there’s a big variety of what you’re seeing with them as far as the work they’re doing. But like generally, how long does it take them from when a new clinic starts or a new provider starts to them getting fully enrolled with the health plan?
Helder Molina (13:56) Usually 60 days, no more than 60 days, okay? Because it’s updating just the roster.
Josh Brunell (14:04) So, you’re submitting only rosters to your payers for the most part.
Helder Molina (14:08) Well, the way because we already have the contract on our side, right? So it’s just updating all the roster for every single insurance that we have… because technically remember, I’m bringing just middle level mid level providers. I.
Josh Brunell (14:23) mean, most.
Helder Molina (14:24) of the time that, you know, the doctors are still the doctors. So I’m adding the mid level, which is a lot easier than just bringing a doctor and credentialing from zero.
Josh Brunell (14:35) Yeah, understood. No. The reason why I ask is, yeah, I was actually in my next question, there are… some organizations we work with where it’s like, hey, yeah, 90 percent of our health plans. We’re doing direct enrollments for where it’s direct at the provider level and they’re not submitting rosters. So for you, the 120 plans you have, you’d say the majority of those are you’re just updating the roster.
Helder Molina (15:05) Most of them, I mean, I will not lie to you that it is 100 percent accurate because again, we got a credentialing company which is the one that make it happen. I don’t know exactly which one is the roster and which one is already updated through the doctor credential inside. But most of them, I will tell you like blue cross blue shield even that a mid level is seeing the patient. It has to be credentialed because it will not go through the doctor.
Josh Brunell (15:31) No, no, 100 percent. Yeah. What I’m just trying to. So what I’m just trying to do is like there is a… the way that we price is based off of a few factors. So if you’re doing direct enrollments at the provider level, it’s just on like a per enrollment basis. If you’re submitting a roster, then it’s on, we charge on per roster. So I’m just trying to understand like of these health plans, what’s the like, how, are you submitting some, a portion of providers to a portion of health plans? And what I could do just to make this easier? I could, I have like a very short like kind of like scoping questionnaire I could send, I could send to you.
Helder Molina (16:14) Send it, send it to me and I will send it to my credentialing people.
Josh Brunell (16:18) Yeah. It’s essentially like, hey, out of the health plans you work with, how many of them are require a roster? What’s the, you know, how many total roster templates? Yeah. And it’s really just about units of work. And like, the more we have volume based discounts. So if you decide to move forward with us and partner with us, it’s really going to be, hey, what are you? What are you interested in committing to upfront as far as volume with us on an annual basis? Or if you want to do a multi year contract that you get obviously bigger price incentives? But what I would think that you’d probably want to see is like over time, how does this scale from 24 to, you know, 50 to 100 providers, and from 30 locations to 50 to 100 locations? And so, what I want to do is I want to model out what the current state looks like, and then what the future looks like with that growth plan you have in mind. And then that way you can see obviously how the cost of medallion on a per unit basis drops over time. So that obviously cause that’s obviously what or for an, you know, executive like yourself that most organizations care about so well.
Helder Molina (17:28) Josh, I will tell you what is my concern so far? Right? Yep. I mean, I’ve been meeting twice already with medallion. I will select three if I count the emails and, you know, so far, at least you tell me, hey, look, can I send you a questionnaire and you can answer it? I mean, we keep talking about the process but nobody’s telling me, you know, okay, what does it cost? That way we can move forward, right? I mean, they have to be something that makes sense. David said, well, we’ll be around 50,000.
Josh Brunell (17:54) And I was like, okay, yeah, let me correct David. We, the reason why I probably asked that is because when we hear 24 providers, that the average, we see is that the average of 24 providers, most companies that we talk to, they have between only like 10 and 15 health plans that they’re enrolling their providers in. You have 120, you have 120. So your volume is much higher. So you probably, he probably heard 24 providers and thought that, okay, you probably like just want to make sure that like, hey, some organizations we talk to, they’ll come to us and then, we say, hey, if you’re only enrolling 24 providers in 10 health plans that’s 240 enrollments, you might not kind of meet what we call like, you know, our deal floor.
Josh Brunell (18:51) But I think for you like, yeah, well, absolutely. Like, I understand your frustration. You talked into two different people. We have this kind of this intake process for routing, but I could get you a, I could get you a quote and a proposal offline. And we can just, I just want to validate what I don’t want to do is tell you the price is one thing we go and find out during implementation that, hey, you need to add more services or you bought more than you should have. So that’s why I just from the scoping standpoint, I’d want to send that questionnaire just to make sure that we have the right number of inputs. And yeah, I want to make sure that this is scoped correctly. So forgive me, no, forgive me if this wasn’t asked. Yeah, yeah, don’t.
Helder Molina (19:32) Don’t don’t worry. I mean it just, you know, it sounds to me, you know, if I tell you how I start with medallion, the answer is like I contacted you through the website that’s not like you only have 24 providers, you know, we are too big for you. I was like, okay, whatever, right? So I was like, but I was like, man, this doesn’t make sense. I’m the second biggest dermatology private on in the United States.
Josh Brunell (19:53) So, when.
Helder Molina (19:54) I got that answer. I was like, okay, you know, it doesn’t make sense to me but it’s fine. But, you know, because we haven’t we work in underserved areas, a lot of these plans, right? They are just assigned to a specifically zip code, right? For some of these insurance. Yeah. And so you got some insurance that come from the church level, right? And you got some insurance that come from the government level. So it’s really like, I mean, I still don’t see the line in the tunnel with the medallion from the fact that I don’t see like we talk about technology side, but it’s still like we keep going through the same question and I’m not judging you, josh. Okay. I’m just telling you as a client, right? And so when we go into all this process, but I don’t see like, okay, so what is going to be medallion doing for us? I still see a lot of variables but I don’t see like how we can come out like, hey, this is what we offer and this is package a, package B or package C. And this is the cost based on what you have. Because I mean, I’m telling you that number right now, the reality is I just purchased two more practices. So technically, if they have any contract that I don’t have, I keep adding to my list and again, you know, blue cross blue shield. I can tell you, I got blue cross blue shield, Texas, I got blue cross blue shield in different states, right? Because I got patients across from Louisiana to Texas, right? But if we look at it from the point of view of the process, it’s the same process of the roster. And I’m talking about the blue cross blue shield because it’s my biggest insurance yep. So, or cigna and healthcare spring. They’re two different things but technically, it’s the same company. So I just want to make sure that I can go through the real process. First of all, everybody’s time is important. And second, I just want to see if you guys are the answer, right?
Josh Brunell (21:43) Yeah, I understand. And yeah, I appreciate that feedback… for us to make sure that obviously we’re the right partner for you like I want to make sure that we’re aligned to some of the things you just mentioned which is like, hey, what I don’t want to be doing is being nickel and dime as I’m adding more clinics and there’s new payers and we’re adding new payers constantly like I get that. And hence why I was trying to ask the questions around the rosters, direct enrollments because as you are, what we don’t want to happen is obviously us coming back and nickel and diming you for things like that’s. Not our intention at all. Ours is what I’m trying to do is just trying to get you the best volume based discount up front, knowing that you’re going to obviously scale and grow with us over time. And so, yeah. And I think what would be valuable is walking you through the platform. Two things on our next call, walking you through a pricing proposal, walking you through the platform, end to end. So you could see it and say, hey, yep, this is not only a good fit from a technical standpoint, this meets my needs. But also you could see the pricing and make a decision from there. Based on that. I will say this like the reason why we’re asking these questions is because we work with a lot of companies where they will be looking for, hey, we want to do this in house and we just want to use your software. And so there’s a miscommunication… up front there or it’s the vice versa of like, hey, we want… to… move forward with you and have you do all of these things for us. However, what we don’t want to do is we want to buy this product and maybe not this product. And so that’s those are the two things I’m just trying to make sure I get right is like I don’t want to sell you something that we, that’s not going to have value to you if it’s not part of, you know, if you’re not doing it, sounds like you’re not licensing your providers, if you’re not doing some of the other services we offer. I just want to make sure that before we get a pricing proposal in front of you, it’s correct. So, forgive me, I will get you, that, the questionnaire sent. And then, yeah, I would love to use the rest of the time here. I know we’re at 30 minutes, but just to set aside some time. With, a solutions consultant on my side to walk you through the platform. And then I’ll come prepared with the proposal. We’ll walk through the products and make sure, hey, this is in alignment for what your expectations are. Perfect.
Helder Molina (24:22) So, can you send me your availability for the next meeting? And I can see my schedule and we can work it out.
Josh Brunell (24:29) Yeah, of course.
Helder Molina (24:32) For sure, will be next week this week. I’m total booked. Yeah.
Josh Brunell (24:37) All good. That actually works better for us too. So, yeah, we’re available.
Josh Brunell (24:49) Monday or Tuesday work better for you?
Helder Molina (24:53) It’d have to be Tuesday, Monday. I’m already booked already, Monday, April 27. I’m already booked 100 percent.
Josh Brunell (24:59) On the 20 eighth, are you going to be back? So text, is that Central Time? Yes? Okay. Would… you have any time really? Between noon and two o’clock.
Helder Molina (25:14) we can do one o’clock.
Josh Brunell (25:15) one o’clock central.
Helder Molina (25:17) Yeah, Central Time, perfect.
Josh Brunell (25:20) That works for us. I’ll get that sent over. I’ll have a couple questions. Some things. I’ll just be like, hey, can you validate this? Like things we already talked about? Number of providers number of payers, all that stuff, and then a couple other questions that I’m going to. I’m going to speak to my technical consultant, making sure, hey, we’re going to obviously walk you through the platform, but then have the proposal ready to walk you through as well.
Helder Molina (25:41) All right, perfect. Thank you very much, josh appreciate.
Josh Brunell (25:44) It, have a good time in columbia. Excited to talk to you next week.
Helder Molina (25:48) Thanks. All right. Thank you, buddy. Thank you. Bye bye.