Medallion CEO Derek Lo

Startups

DHW Q&A: More Care, Less Friction With Medallion

With Derek Lo
CEO, Medallion

In this Digital Health Wire Q&A, we sat down with Medallion CEO Derek Lo to discuss the emergence of virtual care and how to overcome the friction it brought with it.

Derek founded Medallion in 2020 to help healthcare companies automate credentialing, licensing, and compliance for their provider networks. He’s since helped scale Medallion into one of the largest provider network management companies in the US, with over 300 customers and $85M in funding.

Let’s kick things off with some background on Medallion. Can you share a little about the company and your platform?

First and foremost, Medallion exists to improve access for patients – to allow them to receive care where they want it and in the most cost effective way. Virtual care is here to stay, tons of studies are showing that both physicians and patients support it, but with that comes a whole new problem set.

A major component of that is licensing and making sure that telehealth providers can operate efficiently, but the second piece is insurance.

The multi-payor system in the US creates immense complexity, whether it’s claims and the entire revenue cycle industry, or more in our world: credentialing, enrollment, contracting, negotiation. All of these processes are wrapped around taking insurance as a provider.

That’s really what we’re trying to cut down on. We’re aiming to remove as many of these friction points as possible.

To fill in some more color on the platform, what are some of the ways that you remove this friction?

Like I mentioned, Medallion’s main goal is to automate away all of these operational and regulatory compliance tasks that companies have to do just to run their business. That starts with creating a system record for their provider data, so we’ve built our own CRM from the ground up.

What that’s allowed us to do is build different product lines on top of that, automations that tackle various operational pain points in those two main buckets of licensing and insurance.

On the licensing side, that includes things like getting new state licenses, maintaining and renewing licenses, continuing education tracking – all to help with network operations. On the insurance side, that’s where we’re removing friction by helping establish contracts with new payors, followed typically by enrollment, or in some cases, delegated credentialing.

There’s also a huge need for ongoing support with things like roster management, where provider groups have to share their rosters so everyone can track who’s in-network. That’s still a very manual process that a lot of companies are doing with spreadsheets, same goes for sanctions monitoring and compliance. That’s where we come in.

Looking at Medallion’s growth, it seems like plenty of companies share those pain points. How do you guide the direction of a company that’s growing so quickly?

I think a big part of leadership is finding a way to focus on the top one or two problems at any given moment, and being able to drill down on those problems that are right in front of you.

In one way, building a company is just a long sequence of decisions that plays out over many years. It’s the quality of those decisions, in aggregate, that ultimately decides how successful the company is.

There are obviously external factors – a great example being the SVB crisis – but even those are just another decision along the way. It’s our job to make sure that we get those decisions correct and back them with execution.

What’s a misconception that people have above provider management or credentialing?

At the end of the day, if you talk to any healthcare CEO, these functions are a cost center for their organization. They’re a strategic priority, but only because they’re a key gateway to revenue. Yet for that reason alone, people understand that they’re super important to get right.

We talk to companies all the time where things aren’t running optimally, so they’re worried about leaving revenue on the table because they aren’t getting credentialed fast enough, or claims are getting kicked back because enrollment wasn’t done correctly, and so forth.

It’s really important to tackle these problems, not only because of the missed revenue, but because solving them truly makes an impact in terms of growing efficiently, seeing more patients, and ultimately providing better care.

If Medallion had a secret sauce that you could share with other founders, what would that be?

I don’t think there’s necessarily a magic ingredient, but the biggest thing would have to be the execution component we were talking about earlier. That involves doing deep thinking on the market, and really focusing on the customer above all else

What does the customer need? What are their business problems? How are those problems being solved today? How could they be solved in an optimal scenario?

Every day we try to be as thoughtful as possible about how those answers align with what we’re doing and how we’re trying to serve those needs. We also have a fantastic team, so if we can keep focusing on what I just mentioned, in literally as many decisions as possible, then we’ll get a lot of decisions right in the long run. 

For more on Medallion, head over to their website or swing by booth #1831 at HIMSS.

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