Stronger Cash Flow: Camber Health's Take on Medical Billing & Finance

Simone 00:00:01 Welcome to the Flychain Reaction, a podcast designed to empower healthcare providers like you to master the business side of running a practice. Each episode sparks a chain reaction where actionable insights on financial management, operational efficiency, and growth strategies build upon each other, creating a powerful ripple effect to help your organization thrive. With Flychain's financial expertise and insights from industry leaders, we'll dive into everything you need to ignite success. Join us and let the Flychain reactions spark growth in your healthcare business.

Ethan 00:00:40 All right, welcome back to the Flychain Reaction. Today we're gonna be diving into how providers can build a stronger financial foundation for their practice. Excited for today's conversation. We've been partnered with this group for well over two years. I'm joined by Nathan Lee, the co-founder of Camber and one of the best RCM providers that we've certainly worked with, longest relationship we've had specifically in the ABA therapy universe. And yeah, we're excited to chat today, kind of sharing some stories, some real examples, hopefully some actionable tips that you can use. Nathan, it's great to see you, man, and thanks for joining.

Nathan 00:01:22 Thanks for having me here. It's great to be here. And yeah, it's been one of the coolest type of things in last few years to able to partner on some of these specific customer cases, especially for those rapid turnarounds, which I think we've done a handful of now. So that's been great. Excited to dive in and get to it.

Ethan 00:01:39 Yeah, appreciate you joining. And we're gonna to dive into some cool stories here today. But I always think back to when we met two and a half years ago and kind of the first provider, first couple of providers that we worked with, they were on the kind of like backs on the ropes, so to speak. They were kind of on the brink of potentially shutting down. And these are a lot of the same challenges that we see our customers face time and time again. And I thought it'd be cool maybe give a little background on that relationship with those customers, how they work with the Flychain. But I thought it'd be really cool, Nathan, maybe to start off with Camber a little bit and some of the customers that we share together, specifically those that were maybe in a little bit of a problem area. Would love to maybe get your perspective on some of those first couple of customers, the issues that they were having and how we were able to jointly combine to get them out of those rough waters.

Nathan 00:02:37 I remember this first one, it was a word of mouth intro to a Midwest clinic. I think they had two to three dozen different kiddos that they were serving different patient families with pediatric behavioral health services. And I think at that point in our company journey\... so we're coming up on five years now, so this would have been two and a half years into building the company. Most of the early partnerships we did were with these multi-state and a few national organizations. Then we were starting to do more of these local owner operators. And then this one came in through word of mouth.

Nathan 00:03:11 So I remember getting that first intro. It was from an advisor, that was serving on kind of a nonprofit board type of capacity, heard about us and basically said, can I introduce you to the owners there? And when we met with them, it was pretty clear that they were at the end of the rope. And so I remember the conversation one is very quickly turned into, when is the next payroll going to happen and are we going to make it or not?

Nathan 00:03:37 And I actually remember, so I was dialing in and they were at a conference room at their clinic. And I almost felt like I became like a facilitator of their conversation because they were talking about, well, based on cash on hand, how much time do we have? And the advisors were talking with the clinic owner and \[inaudible\] really challenging. The fastest we had ever done an onboarding before that date was like our standard four to six weeks. And I remember they had two and a half weeks or so before missing their next payroll. And so that's when I think I reached out and I was like, Hey, can we make something happen? And that's how we kicked off that conversation. So yeah, I remember that. That was two and a half years ago or so.

Ethan 00:04:19 Two and a half years ago. Yeah. And it's happened time and time again, too. I think when people not just make a billing switch, that can also cause some cashflow issues just based on new people doing new things. But it was sort of this cool combination of, like you're now moving forward with Camber, we need a little bit of cash relief as we're thinking about trying to make this next payroll, making the switch, et cetera. And it was just cool to see our two companies kind of come together, join forces and have an impact on this provider and now many more over the course of last two years.

Nathan 00:04:53 I remember how relieved they were that there was an option to say, Hey, we can actually turn something around super quickly. And so I remember our ends, we had the confidence that based on looking at the historical insurance billing and claims data that Hey, okay. This is a primarily a state Medicaid provider. We know why they're getting the denials that they're getting. Plugged in their historical data into our models. So, okay. It's actually pinpointing those issues pretty early. And then by the time we were having the conversation to say, okay, we should be able to front some amount of money if you guys do an underwriting on this.

Nathan 00:05:27 I mean, props to you guys. I remember, I think you turned around literally within one to two days, maybe even less than a day. And then in the meantime, we were doing the technical integration with their electronic medical record system. We pulled that off in a weekend. I think the disbursement happened early the following week. They got that. And then we started getting set up and submitting claims within, I think it was like a week or two weeks. That was pretty awesome. I think that was one of our\... yeah, I think as an introduction to working together, one of those like, do it under fire type of things. And ever since then, like some situations like that and then others that have been kind of more straightforward or not as a type of a turnaround.

Ethan 00:06:08 Yeah, yeah. We'll touch on some of the crazier things that I think we've done together after that first couple, especially when there were some more existential things that kind of happened within the healthcare universe last year. But no. It's been fun before, before we kind of jump into the nitty gritty, thought it would be helpful to also kind of just talk about the vendor landscape and where our companies fit in. Then we can talk about how this kind of partnership manifests itself.

Ethan 00:06:35 But we kind of think of the world as having a few different vendors that every healthcare business needs. And from Flychain's lens, we kind of see the world almost like bifurcated between more like clinical, financial, operational vendors, and then really just the kind of back office, if you will. So we think of like EMR, revenue cycle management, those systems that are\... having employees, see patients, getting paid by insurance to see them. And then we sit, candidly at Flychain below that line where everyone generally has a payroll system and then an accounting software.

Ethan 00:07:06 And the kind of the magic between our two companies is that integration that we have of being able to look at that granular billing data, not just for the lending pieces, but from our lens, being able to kind of rely on really good data, really good processes so we can not only lend effectively and get repaid, right? That's important for us, but also the data and the analytics that we can share to really kind of have this one plus one equals three relationship where you're handling all of the things at an institutional level on that billing side. We're interpreting that data and then kind of painting a more holistic financial picture for our customers.

Ethan 00:07:42 I'd love Nathan, if you could just spend a little bit of time - and we kind of like almost skipped through this in the beginning, but intro on Camber and how you do that. I think that would be helpful for our listeners, specifically those that might not have heard of you.

Nathan 00:07:56 Absolutely. When we have conversations with a clinic owner operator, we like to just tell them, getting paid by insurance should be as easy as tapping your credit card. Now we both know much too well that that is way easier said than done. Good luck. There's a reason why there's entire ecosystem. The whole healthcare system in United States in general has a lot of these different parties, providers, payers and patients that makes that challenging. But the end of the day, that's really the mission. We exist to say, hey, when you go and render a treatment service, you're seeing your patient on the ground at therapy session. You should just get paid for that session way faster than you're getting paid today and way more.

Nathan 00:08:38 And so the way that we do that, the way we think of ourselves is, yes, we do kind of that back office or mid part of the revenue cycle from when the session is signed and ready to bill all the way to payment posting to make sure that you get paid. But at the end of the day, reason why we do is because we think it should be easy to get paid by insurance and that's not the world today.

Nathan 00:09:00 And so very, very tactically, when we're working with a clinic owner, they're in their electronic medical record system, their electronic health record system. They're doing their schedule. They're taking their notes. They're putting in the patient and provider information, the insurance information. We pull the data from the session and the patient and the provider every single night and we make sure that that session will get paid for perfectly on the first try. And only if we know it's going to be paid perfectly do we submit it. That all happens automatically.

Nathan 00:09:32 Today we see it's around \$2.2 billion worth of annualized claims mostly in the behavioral health, ABA, then also SLP, OT, and PT type of spaces. And we use that data to build models to predict whether or not that claim will get paid. So that's really what we do. And all that prediction means that at the end of the day, you're usually getting paid anywhere between 10 and 20 percentage points more, 10 to 20 cents on the dollar more on that first time that you submit an insurance claim through us. And it just happens automatically.

Nathan 00:10:05 I can talk way more about - I mean, this case that we were talking about, that very first client that we collaborated on is one of those. I've talked with other clinic owners where they tell me, I haven't taken a vacation in three, four or five years, because if I take vacation, no one's submitting claims or I can't cash this check to put the dollars in my bank account for payroll to go out. And we're like, hey, that's not how the world should work. Like we should be able to just make this automatic. And we've invested a lot of time and energy and effort to be building the infrastructure and the technology to make that possible.

Nathan 00:10:35 So that's an overview of what we do. We also support multi-state and national providers doing hundreds of millions of dollars every year of claims. And we're really proud that we can use that same technology to support a national clinic organization all the way down to a clinic down the street and we collaborate on organizations, all scopes and scales in between.

Ethan 00:10:55 Yeah, absolutely. I love kind of your illusion to like taking vacation. Like I think we share that same ethos of like, Hey, this is our bread and butter. Like let us take this off your plate, free up your nights and weekends so that you can have a nice little work life balance to the extent that you can.

Nathan 00:11:12 You can't. I mean, I even - so there were cases in which we had a conversation with a clinic owner that would say something like, Oh, I have a admin person on my team who's great. Now I've been with this person for three, four years. She's awesome. She submits my claims. And I'm like, that's great. And then a month or two later, I get an email saying, Hey, super urgent. That individual took a sick leave or maternity leave or something like that. And cash just stopped.

Nathan 00:11:40 And I think that is the type of reality that we see a lot of times for especially these local owner operators that we kind of take for granted that if that entire operation is on the backs of a single person or people in general, it goes well when that person is there and it goes well. But it takes just a sickness to have things stop. we're like, Hey, we can make this automatic. We can use technology, have that person actually sit on the phone, not talking with United Healthcare, but talk to patient family, right? Like go through digital education with them, go through rescheduling an appointment, helping them back to school. Those types of things, I think, matter way more than sitting on the phone with an insurance company in 2025.

Ethan 00:12:26 I could not agree more. And I think we've alluded to someone taking vacation. We've alluded to little blips in the radar. And I think maybe one thing that you and I have learned over your five years, two and a half years on our end, three years, is that these businesses, while good, are\... they cannot be sometimes that resilient of businesses. Like one little blip in the radar can really throw a wrench into the gear system here. And while we're talking about someone taking vacation, maybe someone like screws up billing, et cetera.

Ethan 00:13:02 But I think the one thing that we've realized and learned it probably the hard way is a lot of these businesses, if they miss like one or two, you know, submission cycles, like it can have a very detrimental impact on their business, even if you're doing everything perfectly. Even if you're billing claims perfectly, there\... we're still kind of at the behest of the payers and the universe there. And I thought it would be kind of cool to switch gears because there was a period specifically last year and then kind of over the turn of this year where two things happened that were candidly out of like everybody's control.

Ethan 00:13:35 And the first one I would point to where I think you and I and our respective teams didn't sleep for a couple months was the Change Healthcare. And I think it was pretty cool where at least first time in my career where something existential happened, Change Healthcare, there was a cyber attack and effectively like one third of all claims in the entire country just ceased to pay. So when you're thinking about running a business where a lot of our customers might have like one, two, maybe three payrolls in their bank account, when the music stops, like how do you continue to keep the lights on, right?

Ethan 00:14:12 And so I thought it'd be cool, Nathan, maybe to talk a little bit about what we were able to do together on - I'll give you our perspective too. And it was very reliant on a lot of the work that you did, but maybe to rewind the clock a little bit. Take us back to Change Healthcare, the hack that third and effectively the sleepless months that we had trying to navigate through this entire debacle.

Nathan 00:14:34 It does feel like almost a dream, a nightmare of sorts of how that's turning things around. For those that maybe are newer to the space or don't know the Change Healthcare cyber attack that happened, the analogy I like to use is if you would imagine that MasterCard or Visa went down, right? And you're running, I don't know, your shop, your coffee store, your Etsy storefront, and you just couldn't take credit cards for a third of all payments. That's basically what happened, which was\...

Nathan 00:15:10 I remember when the\... so we also had the blessing and fortunate connection via our investors to some of the folks that were directly overseeing either on the payer side or very plugged into whether it's hospital health system or large scale providers or investors of other clearing house and technology companies that were really on the inside of this. So I remember, I think we first got the news, it was on Wednesday. A full\... I think it was 30 or so hours before the news broke nationally of, there's something big that's happening right now. And there's kind of all hands on deck situation. And that would be the first warning bell to what became probably\... what maybe the most newsworthy cyber attack type of\... cyber security event in healthcare in the last, what, 20 years?

Ethan 00:16:05 Perhaps ever, at least from my perspective.

Nathan 00:16:09 Certainly since we've been plugged into kind of this ecosystem. And for us, it was first, I think the way that we were able to - we had some investors that directly knew actually the CEO of Availity to fast track us to switch clearing houses. And ever since it actually made us better because we started using a tiered clearinghouse approach where today actually our infrastructure and our systems, we work with multiple clearinghouses agnostically. And so we can actually plug into different clearinghouses. Now, just depending on some pairs have special relationships with certain clearinghouses and you can get a faster time to pay as a result.

Nathan 00:16:49 But yeah. I remember that first weekend, everyone dropped everything across the company and we just\... so we were building connections to new clearinghouse and rewriting a lot of all of our claim submission type of technology, also connecting directly to payer portals. So we were just dropping claims in payer portals. I think we might have been the first technology, claim submission technology provider to have claims back up and running after being on Change and switching to a different clearinghouse. We were back up and running for the majority about 70 to 80% of our claims volume were going back out the door by that Sunday and Monday.

Nathan 00:17:27 And then we were back to 90, 95 by the end of that week. And then we started doing things like dropping where possible by fax and mail and that stuff like that and payer portal submission. So it all turned around very quickly. It was one of the\... I mean, I look back and it's like a nightmare, but I also look back on it fondly because I think it forced us to become better as a company as well. And the last thing I'll say here, just cause I'm going to nerd out too much. Otherwise I'll hand it back to you is one of our SMBs. So we were doing a catch up with them at the end of the year. So this was this last December, 2024.

Nathan 00:18:00 And we were just talking about - we've been working with them for three years or so. And midway through the conversation, she just said - this is a clinic in Nevada. They probably see about three dozen clients. Just said, oh, and I don't know if the Change healthcare thing had any kind of impacts on other clients. But then she just kept talking. And it was in that moment, it was like a half sentence throwaway for her of she didn't even really notice any impact to her operation. But things just kept going. I think that was one of the coolest moments I've had in the last year of, hey, we just made it possible where yes, it's just tapping your card. You should take for granted that you're getting paid. And meanwhile, we knew if so many providers are having massive challenges to hear something like that was really... it was a cool moment.

Ethan 00:18:48 Yeah. It's a testament to the company, the work that you've done creating that resiliency and from our lens during that period, just to give you the other side, because you're running your business with your customers and getting them paid, right? From our lens, anyone who wasn't on Camber, right? That's working with all of these other billers, whether that's internally or through another third party, didn't have that experience where they didn't have the experience where they said, hey, I didn't really realize what was going on, where they were in really dire straits with just no insight into when they were gonna get paid again.

Ethan 00:19:26 And it was really cool from our lens to see that within a week, effectively, like the lights were back on and money was flowing again. Whereas pretty much everyone else that we worked with were just looking into the void, having no idea when they were gonna get paid. And again, we do that advanced payment on claims to help people get through the cashflow issues. And that was really scary from our lens to be working with people, businesses that were not using Camber because we were then advancing money, advancing - helping them cover these payrolls. But again, into this kind of a black box, whereas doing so with Camber customers, it wasn't really risky for us because we saw the money and being able to turn the lights on so quickly and kind of get things back on track.

Ethan 00:20:07 So it's just there's like the haves and have nots. And it was was really, really cool and powerful to see that our shared customers that were on Camber and Flychain were largely not affected or maybe they were affected, but we were able to get them through that with that combination of re-billing through new systems, providing working capital in concert with the trusted partner.

Nathan 00:20:29 And on the flip side, what we saw with folks that weren't on Flychain yet was\... I remember it was hard to get the banks to actually approve lines of credit during this time when it was a black box. So those that we had already created this relationship with that had the credit ready to go, could start fronting that capital, on an established process, no interruptions. But I remember there were situations in which I had clinic owners like through word of mouth, like texting my personal cell to try to get in touch with like, what can we do? And it was way harder to actually advance those types of situations and service because they hadn't set it up yet. And banks were very hesitant, rightfully so to be like, we don't know what this is going to look like in the future.

Nathan 00:21:11 And so, and I'm sure we'll get into this part of the conversation in a bit. Having clinic set up in a resilient way before something like this happens, I think it's probably important. And now whenever I talk with a clinic owner, this is one of the examples that I'm sure we'll go into, my guess is the TRICARE example next, that, hey, there are things that just happen in the universe. And being prepared and being resilient is super important. And it's a little bit of setup upfront for massive payoff in the case that something like that happens. And having that kind of free insurance policy is a no-brainer, especially in this day and age. And I think this is just one example of where that really paid off.

Ethan 00:21:52 Yeah, 100%. And it kind of goes back to the whole topic that we're chatting today, which is building financial resilience for healthcare partners. it's what we always say, preaching from the mountaintops that your RCM is candidly like the lifeblood of your company. If there's a problem there, everything else almost doesn't matter because you're not\... you're not getting paid, therefore you can't pay your staff, therefore you're in rough shape.

Ethan 00:22:19 The TRICARE situation was also yet another one of these sort of like existential, out of our control problems. It was like Change Healthcare, maybe a little less scary in the sense that it was just one payer, but it was a big payer and a lot of our shared customers are on TRICARE. Nathan, maybe to talk a little bit about what happened with TRICARE and then can we give some examples as well as to kind of how we partnered. It's not too dissimilar to Change Healthcare from a cashflow standpoint, but the actual what happened there was fundamentally different.

Nathan 00:22:50 Yeah, and I\... looking back on how that all happened, it's a little bit mind blowing, frankly. The way the transition happens was\... I think there were a lot of lessons learned on the payer side as well. So for those that aren't necessarily in the loop or maybe don't take TRICARE. TRICARE is one of the largest military family insurance funders in the United States. And there was a change of TRICARE, the West region. The administrator of those health care benefits changed behind the scenes, as well as some of the different states and regions switch from the TRICARE East region to the TRICARE West region, and vice versa. A lot of changes happening for members, depending on what state they lived in, how the benefits would be enrolled, as well as even for those that were still in the Tri-West type of umbrella, how they need to have claims routed behind the scenes to a new third party administrator.

Nathan 00:23:46 So that's the high level overarching type of situation. The challenge came into play when we started seeing in our anomaly detection in January, a spiking in routing issues and misconfiguration, as well as initial denial rates, spiking across the board for anyone that was working with TriWest. And this is where all the data analytics we do in the modeling helps where if something doesn't go through the pipes on our system as expected, the way the model predicts, it will flag it as an anomaly through what we call anomaly detection. And we have a lot of this transparent reporting and updates every seven and a half minutes through any kind of information we can get through our systems, a clearinghouse or otherwise.

Nathan 00:24:30 And we started seeing these large spikes. Initial denial rate for TRICARE for us tends to be in the 3 to 7% range. And that includes things like documentation requests and such. It was spiking by 2 to 5X that amount. And we were immediately like, something's wrong here. And it turns out that there are a lot of challenges that providers were having across the entire nation. So that's the setup here. And that started impacting a lot of providers in January or so.

Ethan 00:24:57 Yeah, yeah. And to even like double click on this and why this was such a big story or a big issue that we had to work together to overcome. You've got Change Healthcare on one side of the fence, which was like a black swan event, a hack. While we didn't know when the claims were gonna pay again, we knew what the causation was there. It was a hack. The money that was submitted was gonna pay at some point in time. They just needed to get their ducks in a row, button things up and then ultimately release those funds, whether they did that appropriately or as quickly as they should have, like that's not the point of today's conversation.

Ethan 00:25:32 But this one is a very different yet important thing to flag, which is kind of payers can do what they want to a certain extent. And there's often a lack of communication with our customers and, especially those that weren't on Camber as an example, are kind of left to figure this out for themselves. Like you were able to detect these anomalies before, and then it kind of started trickling out that there's big changes happening in TRICARE. And so most people were kind of left scratching their heads. Why is this not working? And, oh, it turns out that there's this big issue within TRICARE. There's switches. And I'd be lying if I said it didn't cause massive cashflow issues for our customers that we're submitting completely unaware that there was this change and lo and behold, all these things start getting rejected.

Ethan 00:26:18 And so, it's almost like, there's an operational component to this that's more of like the Change Healthcare. But then there's this, what's going on with this payer? And was there legislation that changed? What happened here? And like, if you're not completely uh attuned to what's going on, and that's your singular focus, then those kinds of things like take a little while to manifest themselves with explanations. And sometimes, it's a little too late that like, maybe you've operated for three months, not really realizing what's going on. We experienced that often. We're like, Hey, I haven't been paid by TRICARE for three months. What's going on? We're not doing the billing. We don't actually know. And that's why it's awesome to get this insight. And honestly, troubleshooting through.

Nathan 00:27:01 And there's two different pieces of that, that I think are really understandable with how this works with local owner operators, especially those that are doing this themselves. Maybe they have a biller that they've hired or they're submitting claims themselves on nights and weekends, which is when your focus is really on the reason why you started your practice, which is going to\... \[inaudible\] every case going to be the care that you're delivering. You're not an insurance billing expert. You're not the one that knows how to navigate, let's say for a given insurance payer, oh, I need to call three times because if I get three different representatives on the same payer side, I'm making a slightly different answer and a different insight. I actually need to cross-reference those.

Nathan 00:27:42 Things like that, who has time to sit on the phone to like go through - especially during a TRICARE type of situation where thousands and thousands of individuals are calling in and it's creating huge backlogs. One of the ways that we are actually able to help do that investigation and troubleshooting is we're working with some of the largest payers in the United States or some of the large providers and payers in the United States. And we can actually bundle a lot of our different cases that we're reaching out to a large amount of billables, tens of millions of dollars to say, hey, TRICARE, please prioritize this because there's tens of millions of dollars of disbursement that's being held up for some of our largest national providers.

Nathan 00:28:20 And as we have those learnings, well, the routing issues, for example, where it turns out that PGBA behind the scenes changed the routing ID to different clearinghouses multiple times without notice. When we figure some esoteric technical type of solution out that we got to learn because of our ability to work with this volume, we can then apply that learning to the local owner operator that we also support. And that helps them as well, where they on their own, if they were setting that up, might have taken weeks or months for them to be able to figure that out or wait for the press release or whenever they're going to announce that change.

Nathan 00:28:52 And so I think it makes sense that if you're a local clinic that maybe you're only doing a handful of dozen of client families or something like that, it's hard to do this type of work. And our ability to say, hey, we can use the data and then we can actually go in and talk and work with the insurance payers really helps a lot in these types of situations.

Ethan 00:29:11 Yeah, it's really like that last mile of getting in touch with someone. And that's I think the problem that so many of our customers, specifically those that are maybe on that smaller side of the spectrum, because they don't have those relationships or points of contact. And anyone, if you talk to any business owner that is trying to reach insurance, like you'll realize pretty quickly that it's not an exercise in futility, but it's difficult, right? It's difficult. And so it's almost like the smaller end of the spectrum can actually really benefit because you're having those higher level conversations and you're able to kind of trickle that information down and develop the right processes to help kind of everyone, regardless of your size.

Nathan 00:29:49 Absolutely. And it's actually helped us connect the dots to so many different types of what seem like one-off type of challenges. We get to see the patterns in the data across such a massive amounts of claims and payments across the United States that we can actually tell, oh, for this situation, we actually got knowledge that on the payer end, they changed who was doing, let's say their provider credentialing and rostering. And as a result, the claim adjudication department hasn't linked up the communication between the two.

Nathan 00:30:21 Like things like that, because maybe you'll get a denial or rejection for credentialing and you're like, but I already credentialed that payer - or that provider with that payer. And the worst thing behind this is actually, it's a payer internal communication type of thing. And it's being able to connect those dots way faster because of the volume that we support. And also the data models that we've built, we found that that's massively helped out all providers that we serve across portfolio, large and small.

Ethan 00:30:46 Yeah, for sure. It's kind of interesting again, like we don't do the billing here, but we see a lot of the issues that arise. And that's a very common one where our customers, they're submitting claims, maybe they brought on a new employee that's seeing them and it hasn't just been registered in the payer. And so like, while our customers are operating under the assumption that everything's fine, they don't find out until a month later that, hey, there was some operational issue behind the scenes that we were not aware of. And it's actually not us as the owner's fault. They just didn't do things appropriate on there.

Ethan 00:31:17 And again, another example of how things are kind of outside of your control, but best offense is a good defense when it comes to running a healthcare business. You'll hear us say this a million times. Whatever idiom you want to throw out there, measure twice, cut once, like all of these things, they actually like are - they ring very true here. So I appreciate that specific insight.

Ethan 00:31:39 And also one thing I wanted to highlight advice for providers. So we're kind of like alluding to this now. We've had enough wounds and war stories now, I think to provide some, I think pretty helpful advice to providers. Nathan, in terms of this notion of financial resiliency for your practice, what are some of the things that you would recommend? Because we certainly have some as well, but I would love to get your thoughts.

Nathan 00:32:08 Yes. And right before I go into that, I just want to echo one thing you said, the offense versus defense. I think that's such an important point. We actually have a internal core value for the individuals that help do the investigation and triage and the pattern matching across portfolio, which is something to the effect of never take something at face value. You see a denial that's just for this OA-18 duplicate denial reason. Is it actually the case or do we need to place a phone call to an insurance payer? And is that actually what's happening when they give us a response back? It's\... don't take anything at face value, not because of any fault of any individual. But so many times something just isn't quite as expected and to actually take the intellectual curiosity and digging one level deeper or two levels deeper, I think is really important. I love that you said the offense \[inaudible\] of because I think that's a really important one.

Nathan 00:33:06 Resilience. I would say thematically, the number one thing that I would advise clinic owners to have is a really great understanding of how the business actually works. And that underlies, I think, everything else and the rest of the tactical advice, because in my mind, it starts with a mindset. I've talked with a lot of clinic owner operators, and still do when I can. Go door to door to different local clinics and talk with clinic owners and do meet and greets.

Nathan 00:33:40 I think one pattern that I've seen is, especially in the pediatric therapy space, there's sometimes a kind of uncomfortability for a clinician experienced owner operator to say, hey, I really want to understand the business because it's almost like a, hey, I care about the kids that I'm serving. I don't care about the money or I don't care about the profit. And I think what I've seen thematically is in some cases it leads to a lack of curiosity or rigor around the operation of how the business needs to run. Not for the sake of necessarily making a ton of money or profit, because that doesn't need to be the goal. And I talk with so many owner operators that that's explicitly not the goal.

Nathan 00:34:26 But it does matter for having a sustainable practice that can consistently make payroll, that can have a rainy day fund in case a flood happens or a hurricane happens, especially in Southeast where that's happened and the \[inaudible\]. All the time. So having a great understanding of, I know what a sustainable business looks like and I care about that. I would actually start there. Like that mindset, I think is incredibly important and then we'll get into tactical pieces, but that's where I would start.

Ethan 00:34:57 Yeah. I couldn't agree more. And it's been probably one of the biggest pleasures that we've had at Flychain and honestly working with Camber, which is education and a reframing of thinking. And it's sort of, Hey, like we know that you're often like a clinician at heart. You've gotten into this for all the right reasons, but by starting your own business, now you are now responsible, not just on that clinical side, but that operational side. You have families, kiddos, regardless of the space you're in, but you have families and people relying on you. You have employees relying on you. And again, we've talked about how fragile these businesses can be, whether that's like a self-inflicted wound, something completely out of your control. One or two little billing issues can now all of a sudden put you in a really, really like rocky waters, rough waters rather.

Ethan 00:35:45 So I could not agree more with that. And again, going back to the biggest joys are us meeting with our customers, having them understand the numbers, what is contributing to these numbers and almost being a detective. Like, hey, for me to run a resilient business, let me - it's uncomfortable, but like, let's have a very serious conversation around like, what is not working in our business? Is this something we can fix or is this something that, hey, this is a little outside of my maybe expertise. Let's work with the people that solely focus on this so that they can actually spend more time doing what they want to do and why they got to the space in the first place.

Ethan 00:36:20 But it is cool to see some of our customers now learning and really understanding what net profit is. What does payer diversification mean? Can you make this higher without running out of money? Like when will that break even point be? So it's uncomfortable at times. But numbers aren't scary when looked at, I think, the appropriate way with a goal in mind as well.

Nathan 00:36:41 I remember talking with a Florida based provider. This was probably two, maybe three years ago now that kind of they're on the tail end of going through a challenge like this where they, for six months, had six additional individuals on payroll on a salary basis that were seeing different client families, only 20% of their schedule and 80% of it was dead time or \[inaudible\] time where they weren't working. And it was a conversation which they eventually realized on their own this before we started talking with them that they literally just could not afford to keep those individuals on payroll and actually they had to do some resizing and it was way more painful as a result.

Nathan 00:37:28 And you probably had a lot of those types of conversations where it's a, hey, because we care and we care about building a sustainable business, these are the types of conversations that are really important to have to grow sustainably and grow with resilience. And I think that really matters. Part of the resilience here too is we advise every single local owner operator to go through Flychain's underwriting process in the case that something happens. Hopefully, knock on wood, not a Change Healthcare cyber attack ever again. I hope that the industry has kind of moved forward from something like that and strengthen their tech stacks.

Nathan 00:38:05 Things happen, the TRICARE thing just happened this year. There are constantly challenges of\... it could be a State Medicaid, they feel like they're running out of funding and they're gonna just push back payments for a month. And there's very little you can do as a small provider to influence how that works. And so just starting with, Hey, let's do the financially responsible thing to just have this ready to go in case of any kind of event. I think it's super important. That's one thing I would start with.

Ethan 00:38:31 Yeah, agreed. And kind of on the other side of that coin too, is to think about your business and being financially resilient, yeah, it's good to set up your line of credit with Flychain when you don't need the money. Like it's a very important thing. And to note that like when you have an issue and cash has stopped and now you're like, okay, I need money now to cover payroll. You're now applying from a place of weakness and applying from a place where your financials are also looking weak and therefore you're probably going to get rejected. And so again, it's just one of those things to set up the safety net.

Ethan 00:39:08 On the other side from our lens, it's, I can't think of a more kind of important piece of the business - obviously delivering like ethical care is probably the most important, but from an operational keeping the lights on, growing sustainably, billing is the thing that from our humble purview is the single thing that kills businesses or creates a lot of issues. And it's because of all the things we mentioned, things that are actually in their control even, making sure that their employees are credentialed appropriately. A lot of these things are all solvable to a certain extent.

Ethan 00:39:43 Again, you have to understand the universe that we're playing in. And so having a Camber in that ecosystem honestly turns perhaps something that could be a weaker element of your business into one of your biggest strengths. And something that I think causes so much sleepless nights, apprehension about getting into the space, issues with your business generally arise in some sort of billing state. And so again, we've kind of said this multiple times, whether that was alluding to Change Healthcare or TRICARE. But when we have customers that are having billing issues or might have billing issues or have had them historically, it's a very easy conversation for us to say, Hey, you should probably talk to our friends at Camber because they have this figured out and your business will inevitably be more resilient. They've earned their stripes. They've gone through some of the biggest problems. Therefore they can definitely handle the smaller ones.

Nathan 00:40:32 Yeah. I think I told you the story, Ethan, but for the listeners, one of the things I was really passionate about when we were starting the company, now coming up on five years ago was I have some family friends that run their own clinics. This is in Southern California, pretty small scale. Some of them also before autism therapy was even covered by commercial insurance. So this is back in the 2000s is when they started their practices, because there was just demand and not enough providers for it.

Nathan 00:41:00 And they and almost every owner operator that grew their organizations over a 5 to 10 year period, they would say the same thing. Sometime in their journey, something happened that was unexpected whether it's they didn't realize the provider was not credentialed appropriately, whether a State Medicaid just said, hey, I'm not going to disperse this month. I'm going to wait till next month because I cannot pay you because I don't have the funds where they would then have to text family friends for a few thousand dollars here, a few thousand dollars there to just cover payroll.

Nathan 00:41:31 And I'm talking with owners that made it through that. And I have to imagine, especially after my experience now, so many that did it. And I think first, it's really understandable, I think as I've talked with hundreds of clinician owners of why that happens - which is again, you didn't start your practice or clinic because you want it be a financial expert or insurance expert or anything like that. You want to deliver care. And so it's understandable why that's not top of mind.

Nathan 00:42:01 And at the same time, one of the most important things is to put that, what I would call a core competency in early and starting with that mentality of, Hey, I care about how a business works because I care about delivering care. I care about the providers that I'm taking care of on my payroll because I want to make sure that there's care continuity with ethical and high quality care. All of that matters to say, I need to know how to run a business.

Nathan 00:42:29 And then working with someone like us, we do the same type of education that I'm sure you do on the financial side. We do on the insurance side to say, hey, this is why credentialing and providers through the HR process matters so much. This is why I make sure you have the right background checks and the information on file and you get that prior authorization in time. Here's why it matters so much. And when you do, this is the outcome. And when you don't, here's the challenge. And so same with me, I feel really passionate about educating different providers on that journey because that's what we can do to help support care. I'm not a clinician. I know you're not either. And if what we can do is for those that are delivering that kind of care, make sure that they're set up in a way that they can just focus on that, I think that's a win for everyone.

Ethan 00:43:13 I could not agree more. I think that's why this partnership has been honestly so awesome and successful is like we care deeply about our customers. We have empathy for them being clinicians, their hearts in the right place, often aren't maybe trained on this side of the fence or don't have the bandwidth to actually block and tackle and do this. And so we say at Flychain, it takes a village to run one of these businesses. And you're going to have to pick your other tribes people, if you will, to surround yourself with to make sure that you're running a resilient, awesome business. And that's why we're here. But yeah, Nathan -

Nathan 00:43:46 That's a good thing to also ask if you are working with your own person that's doing this internally or even a different provider. The one thing I always recommend is to say in that village, that person that you're trusting with that remit of doing the billing or whatever it is, how often are you asking questions about, "Hey, bank balance is lower than I expected what's going on," versus how much are they asking you? How much are they pushing information back to you? Going back to offense versus defense. Are they being proactive about the way that they're taking care about you and your financial kind of health and the resilience of your business versus how much are you kind of investigating? I think that's a great place to start and just asking those questions of yourself and those that you work with and setting up that village I think is incredibly important.

Ethan 00:44:34 Yeah, again, couldn't agree more. It's\... use the resources available. And again, the cool thing with\... I think working with some of these like newer companies like ours, we are approaching this from kind of, I don't want to say like a net new mindset, but it's, hey, we need to build products and services in this era to really like highlight and actually solve the problems that people are experiencing on a day to day. Not trying to take historic legacy systems and retrofit them into the world that we live in today. And there's a lot of improvements that have been made. And the whole goal is that those trickle down to have a more successful business to be run.

Ethan 00:45:15 But no, Nathan, thank you so much for joining us today. Any ways that they can get in touch with you? If anyone wants to learn more, I think that would be really helpful to kind of plug here and then we'll let you go, man.

Nathan 00:45:28 Absolutely. I would love for anyone that's interested in having a conversation. You can reach out to us at partnerships@camber.health. Or just go on our website. It's camber.health. Get in touch with us. We love to have a conversation and often they're starting conversations or just, Hey, let's learn about you and the organization that you're running. Tell us everything that we can learn about yourselves and why you're passionate about doing what you do. We love starting there. So looking forward to hearing from any folks that would find that conversation helpful.

Ethan 00:45:56 Yeah, absolutely. And if any Flychain customers want an intro to Camber, you could also go through us too. We'd love to make the intro because again, this partnership has been really awesome and we're just getting started, it feels. So thanks again, Nathan. And I'll probably see you walking around the block. Our office is\... I think that's their office right there.

Nathan 00:46:13 Literally down the street. So looking forward to running into you as well. Thank you for having me on today. It was really productive, so I appreciate it.

Ethan 00:46:20 Appreciate it, Nathan. Take care, man, and have a good one.

Simone 00:46:24 Thanks for tuning in to the Flychain Reaction. If you'd like to keep the conversation going, feel free to contact us at info@flychain.us or schedule a demo through our website at www.flychain.us. See you next time.