April 9, 2025 • 26 mins
Dr. Mary Mason takes us on her remarkable journey from practicing physician to Chief Medical Officer of Centene Corporation in this illuminating conversation about the intersection of medicine and business leadership.
What happens when a physician's analytical mindset meets the corporate boardroom? Dr. Mason discovered her interest in healthcare administration during medical school, choosing to pursue an MBA while maintaining her clinical practice. This dual approach defined her career trajectory as she moved from managing complex cases for 86,000 patients to overseeing Centene's explosive growth from 800,000 to 24 million patients.
Throughout our discussion, Dr. Mason articulates the fundamental differences between medical and business decision-making cultures. Where medicine has clear hierarchies and protocols, business environments often feature ambiguous authority structures and group decision processes that can bewilder clinicians. Yet physicians bring invaluable perspectives to corporate settings - a calm, solution-focused approach captured in her memorable phrase: "Look, nobody died, okay? We can fix this."
The conversation pivots to healthcare's pressing challenges, including the corporate employment of physicians (now 75%), creating scenarios where business executives without clinical backgrounds make decisions affecting patient care. Additional concerns include hospital financial struggles, the technological complexity of modern healthcare, and the worrying trend of physician burnout leading to early retirement.
Dr. Mason's insights crystallize in her book "Think Like a Doctor, Lead Like a CEO," which encourages physicians to recognize their transferable leadership skills while helping business executives understand the value of clinical thinking in corporate environments. Her journey demonstrates how medical training provides an exceptional foundation for leadership roles where clear thinking and decisive action matter most.
Want to discover how clinical thinking can transform business leadership? Dr. Mason's book "Think Like a Doctor, Lead Like a CEO" is available now on Amazon and Barnes & Noble's website.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Welcome to Doc Discussions.
I'm Dr Jason Edwards and thisis the world's best medical
podcast where we havediscussions with physicians to
discover who they are and whatthey do.
I'm joined today by a truerenaissance woman.
She's an engineer, a physician,businesswoman, community leader
, teacher, wife of my friend DrJohn Mason, mother of three
(00:20):
children and an author of a newbook entitled Think Like a
Doctor and Lead Like a CEO.
Welcome, dr Mary Mason.
Speaker 2 (00:27):
Happy to be here.
Speaker 1 (00:28):
Mary, let's start off with your background.
Can you tell me about yourjourney from being a medical
professional to becoming a chiefmedical officer of Centene?
Speaker 2 (00:39):
Yes.
So when I went to med school Ikind of caught the bug of a
student government and I wasintroduced to it in college and
when I got to WashingtonUniversity got very involved
with the leadership of AmericanMedical Association for medical
students really started to getinvolved with policy and even
(01:02):
did six, eight weeks inWashington DC with Senator
Danforth, really focusing onhealth policy and especially
about trying to recruit peopleto primary care.
So after that I came back,started my internal medicine
residency at Barnes Jewish and Iwas starting to realize that
(01:25):
when I was looking around therewas so many I was almost.
I loved medicine but I wasalmost more interested in some
of the business cases and how tomake care more efficient and
higher quality and more costeffective.
And I was offered a chief yearinternal medicine but you were
(01:46):
supposed to take off a yearbefore you started your chief
year to give a little distancefrom the residents.
So I was thinking of doing anephrology fellowship and I was
kind of playing around with thatand then I said you know what
I'm going to go do my MBA.
And so started my MBA and didthat for a year and did
hospitalists at night.
(02:07):
And then when I did my chiefyear, I flipped and finished my
MBA at night and ended upgraduating.
And I was doing my grand roundsfor internal medicine as part
of my chief year and I had DrJim Crane, who was the executive
(02:28):
vice chancellor for the medicalgroup, came to me and said how
would you like to work inmanaged care?
And that was my first managedcare job.
Speaker 1 (02:34):
And so you worked for Washington University.
Speaker 2 (02:37):
I did.
My first job was between WashUPhysician Network and Health
Management Partners and I wasstill practicing two days a week
and then I would do thebusiness side three days a week
and that was really aboutcomplex case management in a
managed service organization.
Bjc and Coventry had a group of86,000 patients at risk and we
(03:04):
were using some of the earlyalgorithms for case management
and complex you know thatcomplex case management, that
you know those high utilizers ofcare, and it was really, it was
really interesting, you know,you know, trying to take that
internal medicine knowledge andapply it in that business sense.
But it ended up the wholeexperiment ended up blowing up
(03:27):
in arbitration two years into it, which is not great for your
first job.
But Coventry then came to meand said how would you like to
be the chief medical directorfor our largest Medicaid plan,
which happened to be in downtownSt Louis?
And so that's how I got intomanaged Medicaid.
Speaker 1 (03:45):
And then, how long did you do that before you
started working with Centene?
Speaker 2 (03:49):
So I was five years I was working on we had, oh gosh,
about 180,000 patients and alot of pregnancy asthma really
started to learn the nuts andbolts of managed Medicaid plasma
really started to learn thenuts and bolts of managed
(04:09):
Medicaid.
And I happened to run into oneof my old attendings from WashU
who worked for Michael Neidorf,the CEO for Centene, and next
thing I know I was in Michael'soffice and he wouldn't take no
for an answer.
That's how it works.
So I started there January of2006.
Speaker 1 (04:23):
And really since that time, I mean, they've had a
meteoric rise.
Yes and the company has growndramatically.
Speaker 2 (04:29):
When I started, we had about 800,000 patients.
When I left Centene in July of2022, we had 24 million patients
.
Speaker 1 (04:41):
That's incredible.
Speaker 2 (04:43):
It was unbelievable the growth, but the mission was
so strong and the initialstrategic plan that Michael drew
up that it really allowed us togrow and to keep to our core
values.
Speaker 1 (05:00):
Yeah, now what problems did you experience or
kind of unique situations didyou come across at your time at
Cent?
Speaker 2 (05:10):
and I'm going to step back and say people always tell
physicians they're not good atbusiness, which I, you know,
(05:30):
it's kind of the old joke, but Ithink many physicians really,
when you start to talk business,they kind of cringe.
And I even found that, you know, even though you know I had a
mathematics background fromundergrad, I had an MBA
sometimes I felt like whenpeople saw the MD, they're like,
oh, do you need help readingthis financial statement?
(05:51):
Or you know, and I'm like, Ithink, it's like, I think I got
it, but you know, thanks forasking.
But you know, I think that it's, you know, so much of being a
physician is being accountablefor your patients and you know
who's in charge.
It's like when you're you know,like when my husband goes in
the operating room, he's theking.
(06:12):
He knows, you know he's the onewho's the buck stops here yeah
the clear hierarchy.
Yeah, absolutely.
Whereas with business it isvery interesting because it's
almost gets to be this groupthing sometimes and you go into
a room and there's 20 peoplesitting at the table and a lot,
and then you're trying to figureout well, why is this person
(06:33):
here and what is this person'srole?
And sometimes you find out thatpeople got invited because
someone didn't want to hurttheir feelings and and so then
you all of a sudden get to thispoint where you're not even sure
who's in charge and who'smaking the decision yeah and I
think that was one of the.
Really that was what I thoughtwas very hard in the beginning.
(06:55):
Um, and because you know theother thing, over the years I
always kept my practice.
Um, you know, I did actually,especially when I got into
centene, start either teachingwith the residents down at wasU
and the residency clinic or atCasa de Salud or another you
know volunteer offices.
But it was always kind of funnyswitching back and forth,
(07:16):
because I like being in chargeof my internal medicine patients
, I mean.
But then to have to come in andsay, ok, who do I have to talk
to?
You know, if I'm going to dothis, who do I have to talk to?
You know, if I'm going to dothis, who else do I need to get
their approval from?
And that's what I think isalways very was very hard in the
business world and still is.
Speaker 1 (07:33):
So I mean, to me that sounds like there's less BS in
medicine than there is inbusiness, but maybe that's me
paraphrasing in medicine thanthere is in business, but maybe
that's me paraphrasing.
Speaker 2 (07:51):
No well, I do think you know to its core in medicine
.
When you think about how youapproach a patient one.
You have a fund of knowledgeand you know.
If I'm an internist and I'mboard certified, you know what
my skill set is.
Now, if I have somebody inmarketing or in operations at a
business, I don't necessarilyknow what their skill set is.
You're not board certified inmarketing or in supply chain.
(08:12):
So, I think that's one thing.
And then in medicine we tend tobe we go by the data.
I mean, think about when yourun a code, you're watching the
monitor, you're looking at thevitals, you're, you know,
getting all that information inorder to make the decision,
whereas business that doesn'talways happen.
Speaker 1 (08:33):
And I guess in business too, you may face some
more unique situations.
I mean medicine.
You face unique situations alot.
But it's kind of within a likea semi rigid framework.
Speaker 2 (08:44):
So, yeah.
Speaker 1 (08:45):
So the path forward is you know either this or that
and you're making a judgmentcall, whereas in business you
may have more options.
Speaker 2 (08:51):
You may, absolutely.
But I also think too, with youknow, and I know my business
team I think I was always, youknow, I got quoted quite a bit.
It's always like look, nobodydied, okay, so something happens
, okay, we can fix this.
You know bit it's always likelook, nobody died, okay, so
something happens, okay, we canfix this.
You know it's like, and don'tpanic, let's not start pointing
fingers at everybody.
(09:12):
let's figure out what we need todo to right the ship and figure
out how to correct this yeahand whereas you know that's, I
think, your doctor comingthrough it's like okay, let's
just cut through it, let's notget emotional.
Speaker 1 (09:25):
Yeah, be as objective as possible.
Speaker 2 (09:26):
And I think that sometimes you know you don't
want a stereotype but I thinkand it depends there's some
business cultures that arefantastic and you know you see
all sorts of differentorganizations in business, but
it does feel like that.
With medicine it's much more.
Let's cut to the chase andlet's let's do what's right by
(09:49):
the patient and let's fix it,and we'll worry about who's to
blame and whose fault and whatwe could have done differently.
Yeah after we fix the acuteproblem.
Speaker 1 (09:59):
Yeah, sure, and so the.
so you kind of you took thisjump from medicine, but you
still continued your practicewhich is I think, a very smart
thing to do worked with Centene,had this kind of meteoric rise
with the company and saw a hugegrowth, and then you decided to
(10:20):
write a book, and I think To methat's art.
There's different types of art,but it takes a lot of courage
to do something like that,because you risk being exposed
as a fool.
You don't know how it will beaccepted, and so I think that's
one of the main challenges increating something is you have
(10:42):
to say, okay, I'm going to takethat risk, I'm going to write
this and people may look at itand say it's great, but they may
look at it and say it's lessthan great.
Speaker 2 (10:50):
And did you have any of those fears or not, really, I
think over the years I kind ofhad that running book of running
list of lessons and it wasfunny because along the way I
had a lot of people tell me youshould write this down, you
really should get this out here.
And in fact I, you know, I wasalways adjunct teaching between
(11:15):
WashU at the School of Businessand between the Social Work
School and now the law school.
So you know I had people sayyou should make a course out of
this, because it's usually theopposite way it's how can
doctors learn from the businessworld how to be that business?
that position, executive,whereas I kind of thought it was
(11:39):
more interesting to go theother way.
But I also think, while I'mhoping in all of this, these
lessons, you know, can be veryuseful for people in business to
kind of see how a doctor thinksI'm also kind of hoping, on the
flip side, that physicians andother clinicians see that you
(11:59):
know, I'm actually better at, Ihave more skills and to be
better at business than Iactually think I am and give
them that confidence to be ableto make the decisions that you
know.
Clinicians are faced with moreand more business decisions
every day, and so I think that'salso very important for
clinicians to be confident intheir skill set.
Speaker 1 (12:20):
Yeah, you know the.
You know you're talking about.
You know whether businessmenunderstand, you know the medical
way of thinking or wherephysicians understand the
business way.
I think actually it was not myidea.
Charlie Munger talked aboutthis, but he talked about
forming a lattice, having kindof multiple fields of you know
some, maybe not expertise, butsome knowledge, whether it's
(12:42):
physics or mathematics orpsychology, and you find out
that, if you can, you know themore of those fields you can
line up, the more accurate andobjectively you can judge
something and make decisions.
And you kind of reach thisLollapalooza where you have some
synergy and I think it helpsyou be better at whatever you're
(13:03):
doing to have someunderstanding of multiple
different disciplines yes,absolutely.
To have some understanding ofmultiple different disciplines
yes, absolutely so.
In your opinion, what are themost pressing challenges facing
health care today, or the healthcare industry today?
I know that's a big question.
Speaker 2 (13:26):
How long do we have, I think, the dramatic change
that we've seen, and it's youknow, it's been gradual over the
last couple decades, but Ithink, physicians being employed
and when you've gone to anindustry where physicians were
independent, they were runningtheir own practices and just
(13:47):
because of the complexity ofmanaged care and payers and all
the paperwork and documentationand quality you name it that
comes with it and now the needfor economy of scale in order to
support a practice, doctorshave found that they really do
need to be part of a largerorganization, and I believe that
(14:16):
one of the studies I waslooking at recently was quoting
that 75% of physicians are nowemployed by a corporate entity,
a hospital or another healthcare organization.
And when that happens, you havebusiness executives often making
decisions about what productsto use, what processes to use,
and the physicians almost become, you know, making the widgets
(14:39):
in the background.
They're the ones who are reallydoing the.
They're focusing on taking careof patients and not necessarily
involved with vetting all theclinical products and all the
different processes that affectpatient care.
And you know, there's somebusiness executives, I think,
who are fantastic, who are ableto, you know, bring in that
(15:01):
expertise and know when to askthe questions.
But you also, you know, oftensee business executives who
don't understand thecomplexities of seeing patients
and don't really understand thatfront lines of where doctors
are seeing patients, and theycan miss a step, and so that
(15:21):
worries me a lot.
Speaker 1 (15:23):
Yeah, I mean.
In many senses a hospital is abusiness, but it's not the same
as other businesses in the sensethat you can't just focus on
profits.
Like a lot of businesses, youhave to take care of the
patients too.
You have to do what's right andmany times that involves losing
(15:43):
money and you still do the rightthing.
And you know in the longtermterm scheme a hospital has
to do that if they want to stayin business is to take good care
of patients.
But you know plenty ofhospitals over the last you know
five years have lost a lot ofmoney.
Yes, and I think you know that'sanother challenge.
You know of trying to figureout how to pay people and kind
(16:08):
of keep the doors open,especially for smaller hospitals
and plenty of which I thinkhave shut down.
Speaker 2 (16:13):
Right, and then also it's gotten to a point where you
look at the complexity ofmedicine.
You really do need ITdashboards.
You need so much data to beable to make thoughtful and
strategic decisions, and,especially if you're a smaller
(16:35):
hospital or if you're a smallerphysician group or you're a solo
practice doctor, you don't havethat type of information, and
so IT solutions can be veryexpensive, but they can also be
very helpful with understandingyour revenue cycle and
understanding gap closure andhow to maximize quality bonuses
(16:58):
and value-based contracting andkeeping track of the 30
different managed care contractsyou may have.
So you know, that's, I think,the one of the other big issues
that you know we're seeing itnow, especially with AI now
coming in, you know, with allthese artificial intelligence
driven technologies is that onceagain, we're adding all this
(17:21):
complexity and it's but, butbecause the system has gotten so
you know, so many people areinvolved in so many regulations
and oversight that you almosthave to have that IT support in
order to be successful.
Speaker 1 (17:39):
Yeah, it makes it hard for those small guys and I
don't know I think the term maybe regulatory capture, but where
you know only the biggersystems kind of survive, and it
seems like the amount of privatepractice groups will only
continue to dwindle andhospitals will likely continue
to merge, and to a point whereyou have, you know, several huge
(18:02):
systems is one theory.
Speaker 2 (18:04):
And that kind of leads into.
You know, one of the otherareas of concern for me is to
this physician burnout andbecause doctors feel that they
aren't necessarily a part of ofall the decisions and they're
not always now in control oftheir destiny you know, they're
just supposed to be doing.
This is what you're supposed todo, because this is what my
(18:27):
employer told me to do.
Yeah, it's.
I think we are seeing earlyretirement of fabulous
physicians and not enoughphysicians coming through the
pipeline, especially in primarycare.
Speaker 1 (18:41):
Yeah, sure.
Speaker 2 (18:41):
To to replace that.
So that's something I think, asan industry, we really need to
address head on.
Speaker 1 (18:49):
Yeah, it seems like manpower in many ways is going
to be an issue and hopefully AIcan kind of help with that to
some degree, Hopefully as longas that opens up another can of
worms.
It's not like the advent ofcomputers in hospitals it just
led to more employees, becauseyou need people to take care of
the computers, so I guess we'llsee which way that goes.
(19:13):
I want to know about youpersonally Are there any things
that you do for your ownpersonal health I'd like to talk
about?
I think doctors are great atdiagnosing disease and stuff
like that, but I think it'simportant to also just talk
about health, like staying ingood shape as far as like
exercise or diet or stretching.
Are there any specific thingsthat you say hey, this has
(19:34):
really helped me a lotpersonally?
Speaker 2 (19:35):
Yeah, we, uh.
I think one of the things my umhusband who we mentioned
earlier, who's been on thispodcast decided when we got
married 30 years ago was youknow, each of us, each week, we
decide, you know, we make surewe each get our time to work out
and schedule it together.
Speaker 1 (19:53):
You know.
Speaker 2 (19:54):
I think that is critical, and especially as we
get older.
You know, making sure it's notjust.
You know I love to spin.
In fact, when I used to travel,I used to pick my hotel
sometimes by what was closest toa soul cycle.
You know, because if I wanted toget that 6am spin in so I could
work all day and just, you know, get out, you know just really
(20:16):
and it really helped me to focus.
But you know weight now, weighttraining I think is critical
and you know just moderation,you know it's, you know just
trying to figure out how to tobalance.
You know, you know eatinghealthy but you know it's okay
to to, you know you have to, youknow you want to go to the
(20:37):
ballpark and have, you know yourburger and fries.
Speaker 1 (20:39):
That's okay too.
Speaker 2 (20:40):
And we try to, you know, really teach that to our
kids as well.
It's it's really about balance.
It's work hard but also, youknow, have time to enjoy and
really take back and find thatstress out.
You know, way to de-stressbecause, you're right, medicine
is a very stressful career andit's you have to have ways to to
(21:01):
balance that because you don'twant to take, you don't want to
take that stress to theworkplace with you, because that
, just that, never goes well foranybody.
Speaker 1 (21:08):
Yeah, you know, when I first started working here, I
realized that, you know, energywas an issue for me personally.
I said I need to do some thingsto make sure my energy level is
higher and you can't do thingsyou know it's the basics,
everybody knows them.
Speaker 2 (21:21):
Well, and I, you know of course we have, because our
youngest loves dogs and pets.
We've got two dogs and a catnow.
But I will tell you, I used toalways tell my patients walking
is one of the best exercises youcan do.
But I got to tell you when youcan do that evening, like walk
after dinner or early in themorning, to get that in, that
(21:44):
makes such a difference in yourday.
And even if it's just, you know, 20 minute walk, just getting
outside walking the dog, it justthere's something I think that
is very therapeutic about it.
Speaker 1 (21:57):
A hundred percent.
It's meditative.
There's research looking intolike what the light does to your
retina and seeing things kindof pass at a certain pace and
how good that is for your mindto kind of center you for the
day.
But I think walking is reallygood for your mental health.
(22:18):
I agree, I think it's like okayfor the body, but the mental
health is huge and so it's areally important thing to do.
And then, yeah, as we get older, as far as bone density and
muscle mass, those really startto go and so it's important to
do the weight training and stayon top of that.
And then my last question foryou I, I I'm making an
(22:40):
assumption that you may read alot.
I try to yes.
Speaker 2 (22:43):
Are there interesting , any interesting books that?
Speaker 1 (22:44):
you've read a lot.
Speaker 2 (22:45):
I try to yes.
Speaker 1 (22:45):
Are there any interesting books that you've
read in the past few years thatyou'd recommend?
Speaker 2 (22:50):
Oh gosh.
Well, one of our favorites inour house is Boys in the Boat.
Okay, I actually was rookedinto rowing in Head of the hooch
in chattanooga in a mixeddouble and, uh, probably the
most terrifying experience of mylife, but um, but you know it
(23:12):
was.
It was um, I learned that Ididn't like rowing.
So no, but it's no, I think.
I think that's a.
I really love those type ofstories of that, those you know,
you know, you know.
Granted, the movie maybe took alittle liberty.
But you know just that, you knowthat human experience and
really hearing the struggles andand how people overcome to
(23:36):
succeed and to really, you know,become a better person.
I love stories like that.
Speaker 1 (23:42):
Yeah, it's the story of life, I think.
Speaker 2 (23:44):
I have to say, the other thing I've been really
enjoying recently is masterclass.
Okay sure Our oldest daughtergave us a subscription to the
family for the holidays.
And I have to say I I've beenlistening to it when I, if I go
work out or swim and I reallyenjoy it I mean there's so many
(24:04):
great.
I mean not only just you knowthere's the business and finance
, but just even how to you knowwork your way through a wine
list at a restaurant, or justyou know decorating tips,
whatever.
Yeah, there's just, it's a lot.
I really enjoy it.
Speaker 1 (24:21):
Did you listen to the Howard Schultz one?
Speaker 2 (24:23):
I have not yet.
Speaker 1 (24:24):
I thought that was that and the Bob Iger one.
No, I have a whole list I'mdying to get to.
Speaker 2 (24:28):
Yeah, you'll never get, yeah, but I think it's the
one thing when you're busy, Ithink, trying to use time wisely
, and I think that's a you know,I know you know books on tape,
but you know podcasts, but but Ithink too that I mean the
masterclass, when, even whereit's come in, I mean five years,
it's pretty amazing.
Speaker 1 (24:49):
Yeah.
Yeah, I think I let mysubscription cancel, but I
thought it was really good.
Speaker 2 (24:53):
I remember when it first started.
It was just a few on there andI was really pleasantly
surprised when I startedbrowsing through it a couple
months ago.
Speaker 1 (25:00):
Yeah, it's excellent.
Well, Mary, thank you so muchfor your insights and experience
with us today.
For our listeners who want tolearn more, Dr Mason's book is
Think Like a Doctor, Lead Like aCEO.
It's on Amazon.
I checked last night.
It had all five star reviews,which is not surprising, and
then I assume is available atbookstores bookstores.
Speaker 2 (25:22):
Yes, we're on barnesandnoblecom.
It's mainly on the websitesright now, but we're working
through all of that.
I was really excited.
It was the first week it cameout.
It was number one new releaseon Amazon for quality management
.
Speaker 1 (25:39):
Very cool.
Speaker 2 (25:40):
And communications and business.
Speaker 1 (25:42):
Yeah, that's exciting .
Speaker 2 (25:42):
Yeah, it was fun.
Speaker 1 (25:44):
Thanks so much for joining us.
Thank you.
Welcome to Doc Discussions.
I'm Dr Jason Edwards and thisis the world's best medical
podcast where we havediscussions with physicians to
discover who they are and whatthey do.
I'm joined today by a truerenaissance woman.
She's an engineer, a physician,businesswoman, community leader
, teacher, wife of my friend DrJohn Mason, mother of three
(00:20):
children and an author of a newbook entitled Think Like a
Doctor and Lead Like a CEO.
Welcome, dr Mary Mason.
Speaker 2 (00:27):
Happy to be here.
Speaker 1 (00:28):
Mary, let's start off with your background.
Can you tell me about yourjourney from being a medical
professional to becoming a chiefmedical officer of Centene?
Speaker 2 (00:39):
Yes.
So when I went to med school Ikind of caught the bug of a
student government and I wasintroduced to it in college and
when I got to WashingtonUniversity got very involved
with the leadership of AmericanMedical Association for medical
students really started to getinvolved with policy and even
(01:02):
did six, eight weeks inWashington DC with Senator
Danforth, really focusing onhealth policy and especially
about trying to recruit peopleto primary care.
So after that I came back,started my internal medicine
residency at Barnes Jewish and Iwas starting to realize that
(01:25):
when I was looking around therewas so many I was almost.
I loved medicine but I wasalmost more interested in some
of the business cases and how tomake care more efficient and
higher quality and more costeffective.
And I was offered a chief yearinternal medicine but you were
(01:46):
supposed to take off a yearbefore you started your chief
year to give a little distancefrom the residents.
So I was thinking of doing anephrology fellowship and I was
kind of playing around with thatand then I said you know what
I'm going to go do my MBA.
And so started my MBA and didthat for a year and did
hospitalists at night.
(02:07):
And then when I did my chiefyear, I flipped and finished my
MBA at night and ended upgraduating.
And I was doing my grand roundsfor internal medicine as part
of my chief year and I had DrJim Crane, who was the executive
(02:28):
vice chancellor for the medicalgroup, came to me and said how
would you like to work inmanaged care?
And that was my first managedcare job.
Speaker 1 (02:34):
And so you worked for Washington University.
Speaker 2 (02:37):
I did.
My first job was between WashUPhysician Network and Health
Management Partners and I wasstill practicing two days a week
and then I would do thebusiness side three days a week
and that was really aboutcomplex case management in a
managed service organization.
Bjc and Coventry had a group of86,000 patients at risk and we
(03:04):
were using some of the earlyalgorithms for case management
and complex you know thatcomplex case management, that
you know those high utilizers ofcare, and it was really, it was
really interesting, you know,you know, trying to take that
internal medicine knowledge andapply it in that business sense.
But it ended up the wholeexperiment ended up blowing up
(03:27):
in arbitration two years into it, which is not great for your
first job.
But Coventry then came to meand said how would you like to
be the chief medical directorfor our largest Medicaid plan,
which happened to be in downtownSt Louis?
And so that's how I got intomanaged Medicaid.
Speaker 1 (03:45):
And then, how long did you do that before you
started working with Centene?
Speaker 2 (03:49):
So I was five years I was working on we had, oh gosh,
about 180,000 patients and alot of pregnancy asthma really
started to learn the nuts andbolts of managed Medicaid plasma
really started to learn thenuts and bolts of managed
(04:09):
Medicaid.
And I happened to run into oneof my old attendings from WashU
who worked for Michael Neidorf,the CEO for Centene, and next
thing I know I was in Michael'soffice and he wouldn't take no
for an answer.
That's how it works.
So I started there January of2006.
Speaker 1 (04:23):
And really since that time, I mean, they've had a
meteoric rise.
Yes and the company has growndramatically.
Speaker 2 (04:29):
When I started, we had about 800,000 patients.
When I left Centene in July of2022, we had 24 million patients
.
Speaker 1 (04:41):
That's incredible.
Speaker 2 (04:43):
It was unbelievable the growth, but the mission was
so strong and the initialstrategic plan that Michael drew
up that it really allowed us togrow and to keep to our core
values.
Speaker 1 (05:00):
Yeah, now what problems did you experience or
kind of unique situations didyou come across at your time at
Cent?
Speaker 2 (05:10):
and I'm going to step back and say people always tell
physicians they're not good atbusiness, which I, you know,
(05:30):
it's kind of the old joke, but Ithink many physicians really,
when you start to talk business,they kind of cringe.
And I even found that, you know, even though you know I had a
mathematics background fromundergrad, I had an MBA
sometimes I felt like whenpeople saw the MD, they're like,
oh, do you need help readingthis financial statement?
(05:51):
Or you know, and I'm like, Ithink, it's like, I think I got
it, but you know, thanks forasking.
But you know, I think that it's, you know, so much of being a
physician is being accountablefor your patients and you know
who's in charge.
It's like when you're you know,like when my husband goes in
the operating room, he's theking.
(06:12):
He knows, you know he's the onewho's the buck stops here yeah
the clear hierarchy.
Yeah, absolutely.
Whereas with business it isvery interesting because it's
almost gets to be this groupthing sometimes and you go into
a room and there's 20 peoplesitting at the table and a lot,
and then you're trying to figureout well, why is this person
(06:33):
here and what is this person'srole?
And sometimes you find out thatpeople got invited because
someone didn't want to hurttheir feelings and and so then
you all of a sudden get to thispoint where you're not even sure
who's in charge and who'smaking the decision yeah and I
think that was one of the.
Really that was what I thoughtwas very hard in the beginning.
(06:55):
Um, and because you know theother thing, over the years I
always kept my practice.
Um, you know, I did actually,especially when I got into
centene, start either teachingwith the residents down at wasU
and the residency clinic or atCasa de Salud or another you
know volunteer offices.
But it was always kind of funnyswitching back and forth,
(07:16):
because I like being in chargeof my internal medicine patients
, I mean.
But then to have to come in andsay, ok, who do I have to talk
to?
You know, if I'm going to dothis, who do I have to talk to?
You know, if I'm going to dothis, who else do I need to get
their approval from?
And that's what I think isalways very was very hard in the
business world and still is.
Speaker 1 (07:33):
So I mean, to me that sounds like there's less BS in
medicine than there is inbusiness, but maybe that's me
paraphrasing in medicine thanthere is in business, but maybe
that's me paraphrasing.
Speaker 2 (07:51):
No well, I do think you know to its core in medicine
.
When you think about how youapproach a patient one.
You have a fund of knowledgeand you know.
If I'm an internist and I'mboard certified, you know what
my skill set is.
Now, if I have somebody inmarketing or in operations at a
business, I don't necessarilyknow what their skill set is.
You're not board certified inmarketing or in supply chain.
(08:12):
So, I think that's one thing.
And then in medicine we tend tobe we go by the data.
I mean, think about when yourun a code, you're watching the
monitor, you're looking at thevitals, you're, you know,
getting all that information inorder to make the decision,
whereas business that doesn'talways happen.
Speaker 1 (08:33):
And I guess in business too, you may face some
more unique situations.
I mean medicine.
You face unique situations alot.
But it's kind of within a likea semi rigid framework.
Speaker 2 (08:44):
So, yeah.
Speaker 1 (08:45):
So the path forward is you know either this or that
and you're making a judgmentcall, whereas in business you
may have more options.
Speaker 2 (08:51):
You may, absolutely.
But I also think too, with youknow, and I know my business
team I think I was always, youknow, I got quoted quite a bit.
It's always like look, nobodydied, okay, so something happens
, okay, we can fix this.
You know bit it's always likelook, nobody died, okay, so
something happens, okay, we canfix this.
You know it's like, and don'tpanic, let's not start pointing
fingers at everybody.
(09:12):
let's figure out what we need todo to right the ship and figure
out how to correct this yeahand whereas you know that's, I
think, your doctor comingthrough it's like okay, let's
just cut through it, let's notget emotional.
Speaker 1 (09:25):
Yeah, be as objective as possible.
Speaker 2 (09:26):
And I think that sometimes you know you don't
want a stereotype but I thinkand it depends there's some
business cultures that arefantastic and you know you see
all sorts of differentorganizations in business, but
it does feel like that.
With medicine it's much more.
Let's cut to the chase andlet's let's do what's right by
(09:49):
the patient and let's fix it,and we'll worry about who's to
blame and whose fault and whatwe could have done differently.
Yeah after we fix the acuteproblem.
Speaker 1 (09:59):
Yeah, sure, and so the.
so you kind of you took thisjump from medicine, but you
still continued your practicewhich is I think, a very smart
thing to do worked with Centene,had this kind of meteoric rise
with the company and saw a hugegrowth, and then you decided to
(10:20):
write a book, and I think To methat's art.
There's different types of art,but it takes a lot of courage
to do something like that,because you risk being exposed
as a fool.
You don't know how it will beaccepted, and so I think that's
one of the main challenges increating something is you have
(10:42):
to say, okay, I'm going to takethat risk, I'm going to write
this and people may look at itand say it's great, but they may
look at it and say it's lessthan great.
Speaker 2 (10:50):
And did you have any of those fears or not, really, I
think over the years I kind ofhad that running book of running
list of lessons and it wasfunny because along the way I
had a lot of people tell me youshould write this down, you
really should get this out here.
And in fact I, you know, I wasalways adjunct teaching between
(11:15):
WashU at the School of Businessand between the Social Work
School and now the law school.
So you know I had people sayyou should make a course out of
this, because it's usually theopposite way it's how can
doctors learn from the businessworld how to be that business?
that position, executive,whereas I kind of thought it was
(11:39):
more interesting to go theother way.
But I also think, while I'mhoping in all of this, these
lessons, you know, can be veryuseful for people in business to
kind of see how a doctor thinksI'm also kind of hoping, on the
flip side, that physicians andother clinicians see that you
(11:59):
know, I'm actually better at, Ihave more skills and to be
better at business than Iactually think I am and give
them that confidence to be ableto make the decisions that you
know.
Clinicians are faced with moreand more business decisions
every day, and so I think that'salso very important for
clinicians to be confident intheir skill set.
Speaker 1 (12:20):
Yeah, you know the.
You know you're talking about.
You know whether businessmenunderstand, you know the medical
way of thinking or wherephysicians understand the
business way.
I think actually it was not myidea.
Charlie Munger talked aboutthis, but he talked about
forming a lattice, having kindof multiple fields of you know
some, maybe not expertise, butsome knowledge, whether it's
(12:42):
physics or mathematics orpsychology, and you find out
that, if you can, you know themore of those fields you can
line up, the more accurate andobjectively you can judge
something and make decisions.
And you kind of reach thisLollapalooza where you have some
synergy and I think it helpsyou be better at whatever you're
(13:03):
doing to have someunderstanding of multiple
different disciplines yes,absolutely.
To have some understanding ofmultiple different disciplines
yes, absolutely so.
In your opinion, what are themost pressing challenges facing
health care today, or the healthcare industry today?
I know that's a big question.
Speaker 2 (13:26):
How long do we have, I think, the dramatic change
that we've seen, and it's youknow, it's been gradual over the
last couple decades, but Ithink, physicians being employed
and when you've gone to anindustry where physicians were
independent, they were runningtheir own practices and just
(13:47):
because of the complexity ofmanaged care and payers and all
the paperwork and documentationand quality you name it that
comes with it and now the needfor economy of scale in order to
support a practice, doctorshave found that they really do
need to be part of a largerorganization, and I believe that
(14:16):
one of the studies I waslooking at recently was quoting
that 75% of physicians are nowemployed by a corporate entity,
a hospital or another healthcare organization.
And when that happens, you havebusiness executives often making
decisions about what productsto use, what processes to use,
and the physicians almost become, you know, making the widgets
(14:39):
in the background.
They're the ones who are reallydoing the.
They're focusing on taking careof patients and not necessarily
involved with vetting all theclinical products and all the
different processes that affectpatient care.
And you know, there's somebusiness executives, I think,
who are fantastic, who are ableto, you know, bring in that
(15:01):
expertise and know when to askthe questions.
But you also, you know, oftensee business executives who
don't understand thecomplexities of seeing patients
and don't really understand thatfront lines of where doctors
are seeing patients, and theycan miss a step, and so that
(15:21):
worries me a lot.
Speaker 1 (15:23):
Yeah, I mean.
In many senses a hospital is abusiness, but it's not the same
as other businesses in the sensethat you can't just focus on
profits.
Like a lot of businesses, youhave to take care of the
patients too.
You have to do what's right andmany times that involves losing
(15:43):
money and you still do the rightthing.
And you know in the longtermterm scheme a hospital has
to do that if they want to stayin business is to take good care
of patients.
But you know plenty ofhospitals over the last you know
five years have lost a lot ofmoney.
Yes, and I think you know that'sanother challenge.
You know of trying to figureout how to pay people and kind
(16:08):
of keep the doors open,especially for smaller hospitals
and plenty of which I thinkhave shut down.
Speaker 2 (16:13):
Right, and then also it's gotten to a point where you
look at the complexity ofmedicine.
You really do need ITdashboards.
You need so much data to beable to make thoughtful and
strategic decisions, and,especially if you're a smaller
(16:35):
hospital or if you're a smallerphysician group or you're a solo
practice doctor, you don't havethat type of information, and
so IT solutions can be veryexpensive, but they can also be
very helpful with understandingyour revenue cycle and
understanding gap closure andhow to maximize quality bonuses
(16:58):
and value-based contracting andkeeping track of the 30
different managed care contractsyou may have.
So you know, that's, I think,the one of the other big issues
that you know we're seeing itnow, especially with AI now
coming in, you know, with allthese artificial intelligence
driven technologies is that onceagain, we're adding all this
(17:21):
complexity and it's but, butbecause the system has gotten so
you know, so many people areinvolved in so many regulations
and oversight that you almosthave to have that IT support in
order to be successful.
Speaker 1 (17:39):
Yeah, it makes it hard for those small guys and I
don't know I think the term maybe regulatory capture, but where
you know only the biggersystems kind of survive, and it
seems like the amount of privatepractice groups will only
continue to dwindle andhospitals will likely continue
to merge, and to a point whereyou have, you know, several huge
(18:02):
systems is one theory.
Speaker 2 (18:04):
And that kind of leads into.
You know, one of the otherareas of concern for me is to
this physician burnout andbecause doctors feel that they
aren't necessarily a part of ofall the decisions and they're
not always now in control oftheir destiny you know, they're
just supposed to be doing.
This is what you're supposed todo, because this is what my
(18:27):
employer told me to do.
Yeah, it's.
I think we are seeing earlyretirement of fabulous
physicians and not enoughphysicians coming through the
pipeline, especially in primarycare.
Speaker 1 (18:41):
Yeah, sure.
Speaker 2 (18:41):
To to replace that.
So that's something I think, asan industry, we really need to
address head on.
Speaker 1 (18:49):
Yeah, it seems like manpower in many ways is going
to be an issue and hopefully AIcan kind of help with that to
some degree, Hopefully as longas that opens up another can of
worms.
It's not like the advent ofcomputers in hospitals it just
led to more employees, becauseyou need people to take care of
the computers, so I guess we'llsee which way that goes.
(19:13):
I want to know about youpersonally Are there any things
that you do for your ownpersonal health I'd like to talk
about?
I think doctors are great atdiagnosing disease and stuff
like that, but I think it'simportant to also just talk
about health, like staying ingood shape as far as like
exercise or diet or stretching.
Are there any specific thingsthat you say hey, this has
(19:34):
really helped me a lotpersonally?
Speaker 2 (19:35):
Yeah, we, uh.
I think one of the things my umhusband who we mentioned
earlier, who's been on thispodcast decided when we got
married 30 years ago was youknow, each of us, each week, we
decide, you know, we make surewe each get our time to work out
and schedule it together.
Speaker 1 (19:53):
You know.
Speaker 2 (19:54):
I think that is critical, and especially as we
get older.
You know, making sure it's notjust.
You know I love to spin.
In fact, when I used to travel,I used to pick my hotel
sometimes by what was closest toa soul cycle.
You know, because if I wanted toget that 6am spin in so I could
work all day and just, you know, get out, you know just really
(20:16):
and it really helped me to focus.
But you know weight now, weighttraining I think is critical
and you know just moderation,you know it's, you know just
trying to figure out how to tobalance.
You know, you know eatinghealthy but you know it's okay
to to, you know you have to, youknow you want to go to the
(20:37):
ballpark and have, you know yourburger and fries.
Speaker 1 (20:39):
That's okay too.
Speaker 2 (20:40):
And we try to, you know, really teach that to our
kids as well.
It's it's really about balance.
It's work hard but also, youknow, have time to enjoy and
really take back and find thatstress out.
You know, way to de-stressbecause, you're right, medicine
is a very stressful career andit's you have to have ways to to
(21:01):
balance that because you don'twant to take, you don't want to
take that stress to theworkplace with you, because that
, just that, never goes well foranybody.
Speaker 1 (21:08):
Yeah, you know, when I first started working here, I
realized that, you know, energywas an issue for me personally.
I said I need to do some thingsto make sure my energy level is
higher and you can't do thingsyou know it's the basics,
everybody knows them.
Speaker 2 (21:21):
Well, and I, you know of course we have, because our
youngest loves dogs and pets.
We've got two dogs and a catnow.
But I will tell you, I used toalways tell my patients walking
is one of the best exercises youcan do.
But I got to tell you when youcan do that evening, like walk
after dinner or early in themorning, to get that in, that
(21:44):
makes such a difference in yourday.
And even if it's just, you know, 20 minute walk, just getting
outside walking the dog, it justthere's something I think that
is very therapeutic about it.
Speaker 1 (21:57):
A hundred percent.
It's meditative.
There's research looking intolike what the light does to your
retina and seeing things kindof pass at a certain pace and
how good that is for your mindto kind of center you for the
day.
But I think walking is reallygood for your mental health.
(22:18):
I agree, I think it's like okayfor the body, but the mental
health is huge and so it's areally important thing to do.
And then, yeah, as we get older, as far as bone density and
muscle mass, those really startto go and so it's important to
do the weight training and stayon top of that.
And then my last question foryou I, I I'm making an
(22:40):
assumption that you may read alot.
I try to yes.
Speaker 2 (22:43):
Are there interesting , any interesting books that?
Speaker 1 (22:44):
you've read a lot.
Speaker 2 (22:45):
I try to yes.
Speaker 1 (22:45):
Are there any interesting books that you've
read in the past few years thatyou'd recommend?
Speaker 2 (22:50):
Oh gosh.
Well, one of our favorites inour house is Boys in the Boat.
Okay, I actually was rookedinto rowing in Head of the hooch
in chattanooga in a mixeddouble and, uh, probably the
most terrifying experience of mylife, but um, but you know it
(23:12):
was.
It was um, I learned that Ididn't like rowing.
So no, but it's no, I think.
I think that's a.
I really love those type ofstories of that, those you know,
you know, you know.
Granted, the movie maybe took alittle liberty.
But you know just that, you knowthat human experience and
really hearing the struggles andand how people overcome to
(23:36):
succeed and to really, you know,become a better person.
I love stories like that.
Speaker 1 (23:42):
Yeah, it's the story of life, I think.
Speaker 2 (23:44):
I have to say, the other thing I've been really
enjoying recently is masterclass.
Okay sure Our oldest daughtergave us a subscription to the
family for the holidays.
And I have to say I I've beenlistening to it when I, if I go
work out or swim and I reallyenjoy it I mean there's so many
(24:04):
great.
I mean not only just you knowthere's the business and finance
, but just even how to you knowwork your way through a wine
list at a restaurant, or justyou know decorating tips,
whatever.
Yeah, there's just, it's a lot.
I really enjoy it.
Speaker 1 (24:21):
Did you listen to the Howard Schultz one?
Speaker 2 (24:23):
I have not yet.
Speaker 1 (24:24):
I thought that was that and the Bob Iger one.
No, I have a whole list I'mdying to get to.
Speaker 2 (24:28):
Yeah, you'll never get, yeah, but I think it's the
one thing when you're busy, Ithink, trying to use time wisely
, and I think that's a you know,I know you know books on tape,
but you know podcasts, but but Ithink too that I mean the
masterclass, when, even whereit's come in, I mean five years,
it's pretty amazing.
Speaker 1 (24:49):
Yeah.
Yeah, I think I let mysubscription cancel, but I
thought it was really good.
Speaker 2 (24:53):
I remember when it first started.
It was just a few on there andI was really pleasantly
surprised when I startedbrowsing through it a couple
months ago.
Speaker 1 (25:00):
Yeah, it's excellent.
Well, Mary, thank you so muchfor your insights and experience
with us today.
For our listeners who want tolearn more, Dr Mason's book is
Think Like a Doctor, Lead Like aCEO.
It's on Amazon.
I checked last night.
It had all five star reviews,which is not surprising, and
then I assume is available atbookstores bookstores.
Speaker 2 (25:22):
Yes, we're on barnesandnoblecom.
It's mainly on the websitesright now, but we're working
through all of that.
I was really excited.
It was the first week it cameout.
It was number one new releaseon Amazon for quality management
.
Speaker 1 (25:39):
Very cool.
Speaker 2 (25:40):
And communications and business.
Speaker 1 (25:42):
Yeah, that's exciting .
Speaker 2 (25:42):
Yeah, it was fun.
Speaker 1 (25:44):
Thanks so much for joining us.
Thank you.
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