This show today is a continuation of our mission/margin series because I wanted to drag into my investigation here what clinical organizations are up to, especially ones that have brought in professional capital, as they say.
Before I kick in here, let me just remind everyone of a few themes that we have been poking in the eyeballs in the past few months over here at Relentless Health Value.
First, patients cannot afford care. Listen to the show with Mark Cuban and Cora Opsahl (EP488) mentioning middle-class wage stagnation. Listen to the show with Merrill Goozner (EP388). Listen to the show with Wayne Jenkins, MD (EP358).
For a full transcript of this episode, click here.
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It is a crapshoot to get medical care these days. Roll the dice and hope you don’t get a bankrupting bill at the end. There’s no transparency (or very little) for patients. No accountability or interest from many. Not all but many take no responsibility for their financial impact on their patients or members.
And look, I am in no way speaking for the vast majority of doctors or nurses or pharmacists or PAs or even really good administrators or anybody else involved in clinical care. In fact, if you listen to the show with Komal Bajaj, MD (EP458) about how many clinicians do not actually trust their leadership will do right by patients or even the clinicians themselves, then yeah.
This is undeniably the broad stroke of this industry we all work in. Many take no responsibility for their financial impact on their patients or members. That is the first theme.
Here’s the second theme. It’s this motto: If you can take it, take as much as you can get. And throwing no shade, but let’s just get real about that.
Right now, healthcare is an industry just like any other industry. And when I say industry, I mean the tax-exempt so-called nonprofits as much as anybody else. Said another way, corporate healthcare leaders, just like any other business leaders, have every incentive to see prices go up. That is just the way commerce works. Listen to the show with Jonathan Baran (EP483, Part 1), the ones with Kevin Lyons (EP487, Part 1 and Part 2).
But what is different than most other commerce endeavors when it comes to healthcare, and Shane Cerone from Kada says this in an upcoming episode, he says, “We don’t have a broken healthcare market. In many parts of the country, there is no healthcare market. The market does not exist.”
And thus prices can go up like rocket ships, because self-insured employers—and also public plan sponsors a lot of times, like state health plans—are, on the whole, just such unsophisticated buyers, price elasticity is, like, nonexistent.
No matter how high the price, plan sponsors still contract for who’s ever in the network; and they and their members ante up and pay the price. Many good and maybe not-so-good reasons for this (not getting into them), but net net, the result is a nonmarket.
Anyone who wants to debate my corporate healthcare entities or big consolidated healthcare entities act just like any other corporate entity, read the recent Substack by Preston Alexander. It’s about hospitals raising capital with bonds.
Preston Alexander wrote, “The financial design of the system has turned what should be a largely altruistic service, one designed for public good and societal benefit, and forced it to act like a financial institution.”
And so, with those bonds, welcome Wall Street. What do Wall Street bankers think about patient care and access and community health? Oh, they don’t think about those things at all. Municipal bond returns, baby. That’s it. Bonds are an investment where people who invest in them, returns are expected, just like shareholders who want their dividends.
Preston Alexander wrote, “Most larger health systems carry billions (that was a ‘b’ back there) in bond liabilities.” It costs money to build buildings and add beds and consolidate, yo; but now they are subject to the same pressures as publicly traded companies.
So then I got my hands on Dan Greenleaf, CEO of Duly, a multispecialty group in Chicago. I was absolutely intrigued from the starting gate because Dan told me that mission can actually beget margin in his view, and he even, at Duly, has private equity investors. So, yeah, I was all ears.
Dan Greenleaf, who is my guest today, by the way, if you haven’t figured that out, told me that because of, but not limited to, the trends above wildly high prices, high premiums, high deductibles, more consolidation, fewer options, scared, confused, and maybe outraged patients—listen to the show with Peter Hayes (EP475)—Dan said that, given this backdrop, actually focusing on mission is a huge competitive advantage. Justina Lehman (EP414) actually also said this in a show from a few years ago.
Dan told me, Dan Greenleaf, when you succeed at mission, you can get yourself decent margin these days.
So, in this first episode, we will talk about this mission of which Dan Greenleaf speaks; and then in part 2 coming at you next week, we’ll get into how that all spells margin.
Here’s what I thought was super important about this whole mission/margin conversation, and Mick Connors, MD, in a show coming up, also touches on this: To achieve mission, you really have to define what mission means. Ben Schwartz, MD, MBA (EP481) said this, too, in so many words in the show from last summer.
And that doesn’t mean just have a gloriously well-written Web page, and you just can’t have spreadsheets of random quality metrics either. You have to treat the mission like you treat any strategic imperative. You gotta break it down and figure out how you’re gonna measure what you’re actually doing. Rik Renard (EP427) talked about this one, too.
At Duly, which Dan Greenleaf talks about in this episode, the focus is on four quadrants of mission: (1) affordability, (2) access, (3) consumer experience, and (4) quality. In this conversation, Dan emphasizes that achieving these four quadrants reduces friction for patients and clinicians and leads to better care outcomes and financial stability.
To be noted with one big fat fluorescent highlighter marker is this: A big part of this mission, in almost each of these quadrants, is about making prices reasonable and predictable and transparent for patients.
In today’s world, that’s what customer experience must include—not just, like, lemon water in the waiting room. That struck me the most.
And all this focus on affordability really adds up across the community. In Chicago, lower-cost alternatives to hospital services can save up to $2 billion. That is also with a “b.” And the communities are also healthier. Crazy. Hey, make sure patients and members can afford and have access to quality healthcare, and the community gets healthier. Who would’ve thought?
Dan Greenleaf, CEO of Duly, my guest today, has been in healthcare for 30 years.
This podcast is sponsored by Aventria Health Group, but I do just wanna mention that Duly so kindly offered Relentless Health Value some financial support, which we truly, truly appreciate.
So, call this episode also sponsored with an assist by Duly.
Here’s my conversation with Dan Greenleaf, and do come back next week for part 2 like I said earlier. Today we talk mission. Next week we talk margin.
Also mentioned in this episode are Duly Health and Care; Merrill Goozner; Wayne Jenkins, MD; Komal Bajaj, MD; Jonathan Baran; Kevin Lyons; Shane Cerone; Kada Health; Preston Alexander; Peter Hayes; Justina Lehman; Vivian Ho, PhD; Mick Connors, MD; Benjamin Schwartz, MD, MBA; Rik Renard; Mark Cuban; Dave Chase; Patrick Moore; Sam Flanders, MD; and Tom Nash.
You can learn more at Duly Health and Care and follow Dan on LinkedIn.
You can also email Dan at dan.greenleaf@duly.com.
Daniel E. Greenleaf is the chief executive officer of Duly Health and Care, one of the largest independent, multispecialty medical groups in the nation. Duly employs more than 1700 clinicians while serving 1.5 million patients in over 190 locations in the greater Chicago area and across the Midwest. The Duly Health and Care brand encompasses four entities—DuPage Medical Group, Quincy Medical Group, The South Bend Clinic, and a value-based care organization. Its scaled ancillary services include 6 Ambulatory Surgery Centers, 30 lab sites, 16 imaging sites, 39 physical therapy locations, and 100 infusion chairs. Its value-based care service line provides integrated care for 290,000 partial-risk and 100,000 full-risk lives (Medicare Advantage and ACO Reach).
Dan has nearly 30 years of experience leading healthcare services organizations. He is a six-time healthcare CEO, including prior roles as president and CEO of Modivcare; president and CEO of BioScrip, Inc.; chairman and CEO of Home Solutions Infusion Services; and president and CEO of Coram Specialty Services.
Dan graduated from Denison University with a bachelor of arts degree in economics (where he received the Alumni Citation—the highest honor bestowed upon a Denisonian) and holds an MBA in health administration from the University of Miami. A military veteran, he was a captain and navigator in the United States Air Force and served in Operation Desert Storm.
08:32 What should mission be in multispecialty?
08:54 Are mission and margin mutually exclusive?
10:47 What are the four “vectors” of Dan’s mission?
11:32 Why does affordability matter?
12:11 EP466 with Vivian Ho, PhD.
12:40 EP488 with Mark Cuban and Cora Opsahl.
13:32 Who are the three payers in the marketplace?
17:31 EP388 with Merrill Goozner.
19:19 How does access play into mission?
22:56 Why price transparency is important to consumer experience.
24:16 LinkedIn post from Patrick Moore.
29:06 EP481 with Benjamin Schwartz, MD, MBA.
You can learn more at Duly Health and Care and follow Dan on LinkedIn.
You can also email Dan at dan.greenleaf@duly.com.
@d_greenleaf of @dulyhealth_care discusses #mission and #margin in #multispecialtycare on our #healthcarepodcast. #healthcare #podcast #financialhealth #patientoutcomes #primarycare #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation
Recent past interviews:
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Mark Cuban and Cora Opsahl, Kevin Lyons (Part 2), Kevin Lyons (Part 1), Dr Stan Schwartz (EP486), Dr Cristin Dickerson, Elizabeth Mitchell (Take Two: EP436), Dave Chase, Jonathan Baran (Part 2), Jonathan Baran (Part 1), Jonathan Baran (Bonus Episode), Dr Stan Schwartz (Summer Shorts)