September 4, 2025 • 28 mins
What if you could get the same high-quality medical imaging at half the price? Dr. Kristen Dickerson turned this question into a nationwide healthcare revolution when she founded Green Imaging after watching hospital acquisitions triple imaging prices overnight in her community.
The radiologist-entrepreneur discovered a powerful insight: most imaging centers operate at just 50% capacity, while 90% of Americans never meet their insurance deductibles and pay full price for medical care. Her solution? Lease unused scanner time directly from imaging centers, perform the interpretations herself, and pass the savings to patients and employers.
Dr. Dickerson shares the fascinating journey of building Green Imaging from a nights-and-weekends side project into a nationwide network that's transforming how diagnostic imaging is delivered and paid for. She reveals how the company maintains its impressive 4.8-star Google rating despite the challenges inherent in healthcare delivery – by combining technological efficiency with genuine human connection.
The conversation explores how different generations access healthcare (from her mother who prefers phone calls to her son who texts), the company's careful approach to AI implementation, and the threats posed by private equity consolidation in radiology. Most compelling is Dr. Dickerson's passionate commitment to transparency and her vision for employers to provide zero-cost imaging for employees while still saving money compared to traditional insurance networks.
Whether you're a healthcare professional, employer, or patient frustrated by rising medical costs, this episode offers a masterclass in healthcare innovation and reminds us that sometimes the most powerful solutions come from rethinking fundamental business models rather than accepting the status quo.
Guest Bio
Dr. Cristin Dickerson is the founder and CEO of Green Imaging, a radiology network dedicated to providing affordable, high-quality imaging services with full price transparency. A practicing radiologist and former managing partner of a large multi-specialty group, Cristin founded Green Imaging to solve a growing crisis: the rising cost and inefficiencies in diagnostic care. Her approach is radically different—building a nationwide network that maximizes underused capacity, bypasses traditional insurance models, and delivers care directly to patients and employers. With a firm belief in human-centered service and innovative care delivery, Cristin is redefining what modern radiology can look like.
- Company Website: https://www.greenimaging.net
- Email (General Inquiries): info@greenimaging.net
- Phone (Main Office): (844) 968-4644
- LinkedIn: https://www.linkedin.com/in/cristin-dickerson-md-a1a1b013/
- Twitter/X: https://twitter.com/GreenImaging
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr Andrew Greenland (00:10):
Welcome back to Voices in Health and
Wellness.
This is the podcast where wespotlight the innovators,
leaders and disruptors shapingthe future of care.
Today, we're joined by DrKristen Dickerson, founder and
CEO of Green Imaging, apioneering radiology service
offering high-quality,affordable medical imaging with
full price transparency.
Dr Dickinson launched GreenImaging with a bold idea what if
(00:31):
you could remove the middlemen,lower costs and still offer
world-class care?
And over the past decade, he'sdone exactly that building a
nationwide imaging networkthat's helping patients,
employers and healthcare workersalike rethink how diagnostic
imaging is delivered and paidfor.
So, kristen, thank you verymuch for joining us this
afternoon and welcome to theshow.
Dr Cristin Dickerson (00:48):
Thanks for having me Excited to have a
great conversation.
Dr Andrew Greenland (00:51):
Thank you, so maybe we could start at the
top.
Can you talk a little bit aboutthe origin of Green Imaging and
what inspired you to start thecompany?
Dr Cristin Dickerson (00:59):
Sure, it was really that I had a problem
in my community, which turnedout to be a national problem,
but that was that there wasn'taffordable medical imaging and
the chain of imaging centersthat was operating in-network
was purchased by a hospitalsystem and the price of
outpatient imaging tripledovernight.
And I was running a radiologygroup.
(01:21):
We were reading for imagingcenters that were operating out
network because they could notsurvive on the network rates and
they were at 50 percentcapacity.
So opening another imagingcenter wasn't going to solve the
problem.
I was going to have the sameproblems these centers did.
So Travelocity and a lot of thekind of shared facility models
were emerging at that point intime facility models were
(01:42):
emerging at that point in time,and so I explored the Stark laws
and because radiologists arenot referring physicians, we're
considered consultants underthose Stark laws because we are
not the referring physician forthe patients that we read the
exams for.
We're able to do uniquerelationships with imaging
centers.
We're able to do per-clicklease arrangements, and so I was
(02:03):
able to construct leases withthe imaging centers that I was
reading for that were at halfcapacity, send my patients there
by the unused time on theirscanners, send my patients there
for the scan and kind offlipped radiology on its head.
Traditionally, an imagingcenter would buy the
interpretation from theradiologist and bill for the
(02:24):
scan and the interpretation billglobally.
And so we decided we would dothe opposite.
We would buy the scan from theimaging center, read the study
and bill globally and share thesavings with self-pay patients.
And really most people in thiscountry should be a self-pay
patient.
90% of people are never goingto meet their deductible and so
(02:45):
they should be negotiatingthe-pay patient.
90% of people are never goingto meet their deductible and so
they should be negotiating thefairest price possible for
themselves.
And at that point in time wehad a very, very high uninsured
rate in Texas as well, and soyou know I proved concept with
self-pay patients.
But I had been a self-fundedemployer and I always knew this
could be great in the employerspace.
And you know, what people don'trealize is that that Blue Cross
(03:06):
Blue Shield card does not meanthat Blue Cross Blue Shield is
paying for that study andthey're insured by Blue Cross
Blue Shield.
Dr Andrew Greenland (03:13):
Most of the time, it's their employer who's
paying for the study, and soemployers are getting smart and
starting to put solutions inplace to save money as well
that's meeting so lots ofefficiencies in what you've done
in terms of maximizing capacityat certain centers, just to all
of these things to try and makethings more affordable for the
patients.
Right, Got it.
(03:34):
So what does a typical day looklike for you as CEO of Green
Imaging?
If there is such thing as atypical day and I dare say there
isn't- there really isn't.
Dr Cristin Dickerson (03:42):
It varies a lot, but I am still a
practicing radiologist, so thismorning, um, you know, I was
reading stat exams and um andreading my routine studies, but
a lot of the time it's going outand talking to educating people
.
That's really what I do.
I just spent three days um indenver with the health rosetta,
which is a conference for healthbenefits advisors and for
(04:08):
employers who want to makechanges.
They want to bootUnitedHealthcare out the window
and start taking on healthcarethemselves, and so I spoke at
that conference, spoke tothousands of people and to
doctors.
They have the Hint Conferenceas well.
Their subscription-basedprimary care is booming in this
(04:29):
country.
Doctors from all specialtiesare going in and doing
subscription-based care.
So they were in Denver as well,and so I really spent three days
with my community.
But that's a lot of.
What I do all day is talking toemployers, talking to benefits
advisors, talking to people whowant to change the way that they
acquire care, and so a lot ofit's just education interesting,
(04:50):
and how has your role evolvedover the years as the business
has grown?
Dr Andrew Greenland (04:54):
I mean, you're in a ceo capacity and
you've been doing this for 10plus years.
How has your role changed?
Dr Cristin Dickerson (05:01):
this was really a side gig for me.
I was a full-time radiologistuntil 2020.
And full-time as a physician ismore than full-time, as you
know.
So I did this kind of nightsand weekends and really had to
subsidize it by being afull-time radiologist.
When it became clear we weregoing to be able to do this
(05:22):
nationally in 2020 and COVIDcame around and you know, the
world kind of changed.
I decided I was going to takethe leap and be full time with
green imaging, and so that'swhen I really, you know, had the
time to get out and starttraveling and go to these
conferences and educate people.
And you know I'm on Zoom callsall day and talking to benefits
(05:46):
advisors and.
HR directors for companies andCFOs of companies and talking,
you know, educating them about adifferent way to acquire health
care for their employees.
Dr Andrew Greenland (05:58):
Fascinating .
What major shifts are youseeing in the medical imaging or
health care space moregenerally right now?
What major shifts are youseeing in the medical imaging or
healthcare space more generallyright now?
Dr Cristin Dickerson (06:05):
There are a lot.
There are a lot of economicfactors going on.
Number one the biggest concernfor everybody should be 65% of
Texans are delaying care or justnot getting care because they
can't afford it.
That's been going on for awhile, but that's up from about
40, 45, 50% a few years ago.
(06:26):
That is huge, and so I thinkthat's the biggest economic
force going on right now.
The other is that employers arepaying more than anybody on the
planet US employers to acquirehealthcare.
That's not getting better forpeople and they're not able to
touch that healthcare.
Their deductibles are so highthat by the time they pay their
(06:46):
premium they don't have moneyleft to pay for care.
And the dirty secret is theydon't have to do that and I'm
seeing employers all over thecountry actually able to provide
care at zero out of pocket fortheir employees and still save
money from what they werespending with the traditional
networks.
And in imaging specifically, itis the private equity
(07:09):
acquisition of imaging centersand radiology groups and the
result there several factorsthere Hospitals are having.
With the first factor Idiscussed, hospitals are having
to increase the price of theirimaging so they can try to get
to the health plan above thedeductible because patients
can't afford this debt.
(07:29):
You know they're collecting 26cents on the dollar from
patients.
Private equity acquisition ofimaging centers means a friend
of mine sold some centers inHouston to a large chain of
imaging centers.
He said his EBITDA tripledovernight.
What he could make from thecenter tripled overnight because
their contracted rates were somuch higher than his.
(07:50):
That also means that everybodywho hasn't met their deductible
when they go to that imagingcenter.
They used to have really fairprices.
They had their cash prices andtheir contracted rates.
Now when they go there they'regoing to have a surprise bill
because the rates have tripledovernight.
And then the acquisition ofradiology groups means that the
(08:11):
surprise bill that people usedto get in November, december
from the radiology group thatthey didn't know they were going
to get a bill from actually maybe as high as the facility bill
.
We're seeing the professionalfees have just dramatically same
reason.
They're aggregating contracts.
You know bigger groups cannegotiate and get more leverage
(08:31):
with the payers and so againthat surprise bill may be as
high as the bill for the scanitself.
Dr Andrew Greenland (08:41):
I guess your operation must look fairly
attractive to a private equitygroup.
Is this something you'd betrying to kind of avoid and hang
on to this yourself?
What's your kind of take onthis?
Dr Cristin Dickerson (08:50):
Yeah, I mean, you know there are
strategic, there are privateequity groups that are trying to
pull together solutions thatcan hold down costs and replace
the traditional system, that canhold down costs and replace the
traditional system.
That's not something I'minterested in right now.
We're 100% radiologist ownedand operated.
(09:11):
I own 90% of the company andwe're completely bootstrapped.
But at some point, thefinancial risk of that just
becomes overwhelming and ourneed to automate, our need to.
You know, ai is not and that'sanother point of discussion
always is AI and imaging, butyou know all of the things that
we need to do to automate, tostreamline this and hold down
(09:34):
cost.
Ultimately, costs are aninvestment and so, you know, at
some point I will need investors, but they got to be the right
kind of investors.
That's very clear, you know.
We've stayed clear of that fora long time, intentionally and
thinking about.
Dr Andrew Greenland (09:52):
You know your clients.
I mean, how have millennialsand Gen Z clients changed the
way you approach the patientexperience?
Dr Cristin Dickerson (09:59):
it's very interesting.
We feel like we have to takeclients in whatever
communication mode they want.
My mom wants wants to call, Iwant to email and my son wants
to text, and that's just the wayit is.
And so we have multimodalintake for imaging orders.
And you know it literally issome people just want, you know,
(10:20):
to talk to somebody who speakstheir language on the phone.
And we found that during COVIDour average phone call doubled
in length and fortunately ourvolume had decreased by 50%.
So we were able to accommodatethat.
But it's very interesting whenpeople are under healthcare
stress, they really want a realperson, and that even includes
(10:40):
that our web chat is made byreal people.
It's not bots, it's not AI, itis real people responding to
people.
So we feel like there are a lotof different ways and the
younger people, a lot of theentire process can be handled by
(11:01):
secure text.
So even our older peopleusually will receive a text on
their phone.
But a young person justbasically takes a snapshot of
their order and their benefitscard.
Uh, text, that term, mainnumber.
That starts the referralprocess and you know they'll
have a voucher on their phone.
Gives them the date and time ofthe exam, uh, the address of
(11:23):
the facility and any prep neededfor the exam and what's?
Dr Andrew Greenland (11:27):
what has green imaging had to do to adapt
to these kind of requirementsfrom your clients?
You've talked about variousmodes of communication,
particularly young peoplewanting texting, all these kind
of things.
Have you had to put things intoplace to cater for these
demands?
Dr Cristin Dickerson (11:43):
It's really cybersecurity.
That is what we're having toadapt to.
I can't tell you how many timesa day we get attempted
cybersecurity threats.
We are.
We we've been stuck to audited,stuck to type two, which is
even a higher level audited, notbecause we're a company that
(12:03):
size that should have to do that, but because we are aggregating
data of PHI and we feel aresponsibility to do that.
But because we are aggregatingdata, health, phi and we feel a
responsibility to do that.
And so you know it's really.
I think the expensive and thehard part of doing this is, you
know, being loose enough toaccept people communicating with
(12:23):
us in all different ways, buttight on the cybersecurity.
So that's really the challengethere.
Dr Andrew Greenland (12:30):
Got it, and do you see these generational
demands as temporary trends orpart of a broader, lasting
transformation in what you do?
Dr Cristin Dickerson (12:38):
I think it's a broader, lasting
transformation, although whenpeople are under again, when
people are under healthcarestress and they are, even if
they're having a screening study, having a screening mammogram
you know, the best day of theyear is when you get your normal
screening mammogram result.
So even if people are gettingminor what we consider minor
testing done, they're understress when they reach out to us
(13:00):
and so it's really keeping tome.
How do we communicatesuccinctly, in a frictionless
way and still have the warmththat human beings need?
And that, to me, is thechallenge.
I don't think people are goingto read the whole text anymore,
ever again.
(13:21):
They're never going to readprose.
But you know, I think thisproneness we have to everything
moving fast will continue.
But I still think in healthcarewe number one.
We have to restore trust inhealthcare.
It's gone away, and so whenpeople's employers put green
imaging in place, they're alwaysskeptical this is just a cost
(13:42):
containment something.
So we have to get past that.
We have to let them know we'rereal people who really care
about them and are really goingto take great care of them.
And so we have to.
We have to amp it, that pieceof it, up, so much to get past
the brevity that everybody wantsand needs.
Dr Andrew Greenland (14:01):
Thank you, and I'm thinking about the green
imaging as a business.
What's working really well foryou in the company from from
your perspective and your team'sperspective.
Dr Cristin Dickerson (14:11):
I really think it's that.
It's the human touch.
If you look at our Googlereviews, we have 4.8 Google
stars, despite the fact we'repracticing healthcare, which
does not always go perfectly,and I think if you look at those
and read them and see howappreciative people are, or they
call our concierge shop by nameover and over again, and I
(14:31):
think that's really thedifference.
You know you can use an app togo find an inexpensive place to
get imaging.
Now we're not.
We don't want to be thecheapest place to get imaging.
We want the imaging centers towant our patients.
We want them to take great careof our patients.
Open evenings and weekends forour patients.
When we have a large group in atightly geographically
(14:53):
aggregated area.
But you know, anybody can findan imaging center.
It's the piece on top of it,the being cared for and the not
having to hang on the phone foran hour to get an off and to get
your appointment taken care of.
Those are the things that Ithink really make a difference.
Dr Andrew Greenland (15:12):
Well, congratulations on achieving
those kind of reviews, becausethat's very powerful.
We all know the power of theGoogle review and, similarly,
what's been particularlyfrustrating or challenging in
what you do.
Dr Cristin Dickerson (15:22):
It's the variation in how claims are
processed.
I mean, every doctor on theplanet understands this.
You know the billing issues wedid.
Originally we just did invoicesto our employers and to our
TPAs, but it became clear toscale we had to do EDI, which is
, you know, the electronic waythat claims are processed in
(15:45):
this country, and you know weare not contracted with who we
call the BUCAs the Blue Cross,Blue Shield, United, Cigna,
Aetna plans, intentionally.
That's just that didn't work inmy old life, I hated it, and so
you know we're not contractedwith those.
But the independent TPAs are aschallenged or have as difficult
(16:08):
a time processing claimscorrectly as the larger ones do,
and so I think the realfrustration has been again, just
like in a traditional practice,it's getting paid.
Dr Andrew Greenland (16:24):
And from another sort of business
perspective.
I guess there are a number ofmetrics that you're particularly
interested in.
Can you tell us a little bitabout the kind of things that
you pay particular attention toand perhaps the things that
you're most interested inimproving?
Dr Cristin Dickerson (16:37):
Yeah, you know.
Number one is our net promoterscore.
You know how we're doing withpatients.
How would patients recommend usto friends and family?
And that's first and foremostUm o are.
You know how quickl you knowaccess to care problem and how
(16:57):
quickly w scheduled Um can weget our preferred sites.
Do w sites that we've got greathat we're using on a dal.
Appreciate us, you know.
Help us hold down costs, takegreat care of our patients, hold
spots on Friday afternoon forus so that if we have a staff,
we can keep somebody out of theER.
(17:18):
Those are all things thatreally matter to us.
You know, from a financialstandpoint, you know obviously
there are metrics.
You know we've got to.
You know you can't have amission without a margin.
And obviously there are metrics.
You can't have a missionwithout a margin.
And so trying to keep the 10%margin going so that we can
(17:39):
continue to grow and take careof our employees is, of course,
critical for any medicalpractice and challenging.
And those are the things thatmatter.
Dr Andrew Greenland (17:51):
Brilliant and which are your biggest
bottlenecks right now in termsof what's going on in the
business?
Dr Cristin Dickerson (17:59):
I would say there's certain geographic
areas that are really, reallychallenging for us when they're
hospital dominant.
The Northeast is a challengefor us, geographically largely
hospital-based, They'vemaintained great reimbursement
with the payers because theirpatients are more spread out
(18:20):
geographically and there arevery few independent imaging
centers in those areas.
Boston has been a challenge forus.
Wisconsin has been a challengefor us.
It's really made.
Wisconsin has been a challengefor us.
It's geographies where it'schallenging to find facilities
for our patients.
Dr Andrew Greenland (18:39):
If you could wave a magic wand and fix
one thing in the businesstomorrow and we'll take billing
as a given, because that's akind of universal thing to North
America what would that thingbe?
Dr Cristin Dickerson (18:50):
Chaos, the dramatic variations in how
health care is provided.
I saw a statistic yesterday, orI heard a statistic yesterday,
that it's not just what it'scosting employers directly to
provide health care for theiremployees.
It is the time their employeeshave to spend away from work to
(19:18):
acquire health care.
There's a second cost and thatis how much time they have to
spend acquiring health care inthe current system, and it's all
because of the chaos and thebarriers that are put in front
of patients to acquire care.
Dr Andrew Greenland (19:31):
Interesting .
Maybe talk about growth in amoment, but I was going to ask
if you had a sudden influx ofnew leads or clients.
Obviously a nice problem tohave, but what would break first
in your system?
Dr Cristin Dickerson (19:45):
What would break first?
Probably geography.
What would break first?
Probably geography, and we dohave a huge influx coming in for
the end of this year and thebeginning of next year.
The challenge is geographicbuild out of the network and not
just geographic build out.
Our original model where we readthe studies is the best because
(20:06):
we control the images and thereports.
And access to images andreports is a problem for doctors
across the country.
Getting, getting you knowreports, auto fax to them.
They don't come a lot of thetime.
Even if you look at a doctor'sprescription pad, a lot of times
the fax number that's on thereis not the one where they really
(20:27):
want the reports going and itgoes into a dark hole.
And so access to images andreports is a challenge.
And so really, our getting backto our original model where we
read the most of the studies iscritical for us and a limiting
factor, and we'll get there.
(20:48):
It's just to get big and tohave enough facilities to do
this nationally.
We had to serve as more of atraditional network, even though
it's still our radiologists whoare protocoling the exams, even
though it's still ourradiologists who are protocoling
the exams.
It's our radiologists who are.
You know, if there's ever aquestion of quality, we're going
in there and looking at it.
We're reading about 43% of theexams right now and we need to
(21:10):
get back up to, you know, 75probably is realistic and
control those images and reports.
Dr Andrew Greenland (21:17):
And that is , you know, what keeps things
slick and moving nicely is therea creative fix for this
geography problem that you'veyou've mentioned, or are you
just really stuck with where,where things are in in space?
I'm just trying to get a senseof what the what, the creative
solution for this is well, Ithink hospitals are starting to
listen to us.
Dr Cristin Dickerson (21:37):
we're starting to have a really good
value prop for hospitals.
When I built this, I you know Ihad five imaging centers and so
I know their pain points,including hospitals.
You know we provide cleanradiologists protocol orders.
We there's no authorverification on their part.
(21:57):
We pay their fair price and wepay them promptly and so we
answer a lot of the pain pointsand for hospitals right now it's
trying to collect from patients.
So if I can get the rightperson at a hospital, I can
usually convince them to workwith us and we've done that.
We have some really greatrelationships in Texas now with
hospitals.
We have Baptists in San Antonio, we have Ascension in in Waco,
(22:20):
we're about to work withAscension in Temple and we work
with Oak Bend in Richmond, texas.
We really are starting to getthose relationships rolling.
I think that will solve ourproblem down the line.
It's getting to the rightperson at the hospital and
they're having open ears.
But if I get to them I canconvince them that this is a
better way to do things.
Dr Andrew Greenland (22:42):
I mean, you've been doing this about 10
years now, and so if you werestarting your business again
tomorrow, what would you dodifferently with everything that
you know and everything thatyou've been through?
Dr Cristin Dickerson (22:50):
Gosh, I don't know.
Resilience is such a it sodrives doing things better that
I don't know that I'd tradeanything or do anything
differently.
It really did take walking thispath and really learning the
mechanics.
I guess I would have learnedthe mechanics of healthcare
(23:11):
better, of how healthcarepayment systems work, how
third-party administrators work,how stop-loss works, the
catastrophic coverage thatemployers put behind their plans
.
I think I've probably I havebecome a benefits advisor, just
in self-defense and I probablywould have done that Now.
I was actually a managingpartner of a big multi-specialty
(23:33):
group early in my career, so Ialready knew the traditional
system pretty well.
But it's really once you getinto the mechanics of an
individual health plan where,had I had that knowledge earlier
, we would have averted someproblems.
Dr Andrew Greenland (23:52):
Thank you.
It sounds like you run a fairlystreamlined operation, but are
there anywhere areas that youfeel like you're perhaps behind
the curve?
I don't know whether aspects oftechnology, operations or
marketing.
Is there anything that you feelthat you have to catch up on?
Dr Cristin Dickerson (24:06):
You know, if any, I would say automation.
Except we're very cautiousthere.
You know, one of the thingswe're learning kind of the first
round of radiology AI hasfailed and I was very skeptical
about going into theinterpretive part of AI.
We have no investment therebecause we've all been through
the computer aided detection.
(24:27):
You know Medicare's paidbillions of dollars for
mammography computer aideddetection that does nothing more
than an experienced radiologistcan do and so I've gone into
that very skeptically.
Now we have used AI where wecan't nothing patient facing,
but we've used it.
I use it to organize myradiology report so I never have
(24:49):
to take my eyes off of theimages I can dictate and it puts
it in the proper order.
Of course I oversee that, but Iuse that to add.
It adds maybe 15 percentefficiency and time to my work.
But the hassle factor and Ithink my ability to interpret
(25:09):
and not be interrupted, nevertaking my eyes off to go make
sure I'm in the right place onthe report is really really
helpful.
Even if it didn't add theefficiency, I think I would use
it for that reason.
So I'm you know we're watchingvery carefully.
Now I do know that when weapplied for our malpractice this
(25:29):
year.
They were going to ding us forusing any interpretive AI.
We were going to have a higherrate because they're
experiencing malpractice issueswith some of these.
So I think I'm not going to saywe're behind the curve on that.
We're watching it veryskeptically and we will jump in
(25:50):
when we find solutions that wethink really benefit ourselves
as physicians and our patientsGot it.
Dr Andrew Greenland (25:58):
As CEO.
What keeps you up at night whenit comes to the future of green
imaging?
Maybe nothing, but I justwondered if there's anything
that kind of stirs you in yoursleep as a manager in your
business.
Dr Cristin Dickerson (26:10):
Sure, growing too fast and not being
able to take care of peopleoptimally, that's my fear and
there's a lot of interest inwhat we're doing right now and
you know we're just having to.
I mean, you know, kind of evengoing to this conference was a.
You know we had so much influxof people interested in new
(26:30):
business and we pretty much haveour channels full for next year
.
So you know it's how do webalance that?
Keep people interested andoptimistic for change, but scale
it smartly, intelligentlyintelligently?
Dr Andrew Greenland (26:51):
I hear you.
What about the future?
So where would you like greenimaging to be in six to 12
months time?
Is it around the growth thing,or are there other things that
you've kind of got your eye onfor the future.
Dr Cristin Dickerson (27:01):
For me it would be getting patients
through the pipeline as morequickly you know being and being
able to really um take on.
You know we've had about 30growth year over year in um in
patient care and being able toadd 50, 70 and so we can help
(27:21):
more people would would belovely wonderful.
Dr Andrew Greenland (27:26):
Kristin, thank you so much for your time
this afternoon.
It's been a really interestingconversation hearing about what
you and what you do at Green,imaging the model that you have
and how it's so different fromwhat other people are doing, and
your very honest and informeddescription of how you do your
thing.
It's really really interesting.
So thank you so much for yourtime, really really appreciate
it and I'm sure other peoplewill be interested to hear what
(27:48):
you have to say, and we'll putyour contact details on the bio
page of the podcast so anybodywho wants to get in touch or
find out more will be able to doso.
But thank you very muchfantastic thanks for having me.
Dr Cristin Dickerson (28:01):
Thank you.
Welcome back to Voices in Health and
Wellness.
This is the podcast where wespotlight the innovators,
leaders and disruptors shapingthe future of care.
Today, we're joined by DrKristen Dickerson, founder and
CEO of Green Imaging, apioneering radiology service
offering high-quality,affordable medical imaging with
full price transparency.
Dr Dickinson launched GreenImaging with a bold idea what if
(00:31):
you could remove the middlemen,lower costs and still offer
world-class care?
And over the past decade, he'sdone exactly that building a
nationwide imaging networkthat's helping patients,
employers and healthcare workersalike rethink how diagnostic
imaging is delivered and paidfor.
So, kristen, thank you verymuch for joining us this
afternoon and welcome to theshow.
Dr Cristin Dickerson (00:48):
Thanks for having me Excited to have a
great conversation.
Dr Andrew Greenland (00:51):
Thank you, so maybe we could start at the
top.
Can you talk a little bit aboutthe origin of Green Imaging and
what inspired you to start thecompany?
Dr Cristin Dickerson (00:59):
Sure, it was really that I had a problem
in my community, which turnedout to be a national problem,
but that was that there wasn'taffordable medical imaging and
the chain of imaging centersthat was operating in-network
was purchased by a hospitalsystem and the price of
outpatient imaging tripledovernight.
And I was running a radiologygroup.
(01:21):
We were reading for imagingcenters that were operating out
network because they could notsurvive on the network rates and
they were at 50 percentcapacity.
So opening another imagingcenter wasn't going to solve the
problem.
I was going to have the sameproblems these centers did.
So Travelocity and a lot of thekind of shared facility models
were emerging at that point intime facility models were
(01:42):
emerging at that point in time,and so I explored the Stark laws
and because radiologists arenot referring physicians, we're
considered consultants underthose Stark laws because we are
not the referring physician forthe patients that we read the
exams for.
We're able to do uniquerelationships with imaging
centers.
We're able to do per-clicklease arrangements, and so I was
(02:03):
able to construct leases withthe imaging centers that I was
reading for that were at halfcapacity, send my patients there
by the unused time on theirscanners, send my patients there
for the scan and kind offlipped radiology on its head.
Traditionally, an imagingcenter would buy the
interpretation from theradiologist and bill for the
(02:24):
scan and the interpretation billglobally.
And so we decided we would dothe opposite.
We would buy the scan from theimaging center, read the study
and bill globally and share thesavings with self-pay patients.
And really most people in thiscountry should be a self-pay
patient.
90% of people are never goingto meet their deductible and so
(02:45):
they should be negotiatingthe-pay patient.
90% of people are never goingto meet their deductible and so
they should be negotiating thefairest price possible for
themselves.
And at that point in time wehad a very, very high uninsured
rate in Texas as well, and soyou know I proved concept with
self-pay patients.
But I had been a self-fundedemployer and I always knew this
could be great in the employerspace.
And you know, what people don'trealize is that that Blue Cross
(03:06):
Blue Shield card does not meanthat Blue Cross Blue Shield is
paying for that study andthey're insured by Blue Cross
Blue Shield.
Dr Andrew Greenland (03:13):
Most of the time, it's their employer who's
paying for the study, and soemployers are getting smart and
starting to put solutions inplace to save money as well
that's meeting so lots ofefficiencies in what you've done
in terms of maximizing capacityat certain centers, just to all
of these things to try and makethings more affordable for the
patients.
Right, Got it.
(03:34):
So what does a typical day looklike for you as CEO of Green
Imaging?
If there is such thing as atypical day and I dare say there
isn't- there really isn't.
Dr Cristin Dickerson (03:42):
It varies a lot, but I am still a
practicing radiologist, so thismorning, um, you know, I was
reading stat exams and um andreading my routine studies, but
a lot of the time it's going outand talking to educating people
.
That's really what I do.
I just spent three days um indenver with the health rosetta,
which is a conference for healthbenefits advisors and for
(04:08):
employers who want to makechanges.
They want to bootUnitedHealthcare out the window
and start taking on healthcarethemselves, and so I spoke at
that conference, spoke tothousands of people and to
doctors.
They have the Hint Conferenceas well.
Their subscription-basedprimary care is booming in this
(04:29):
country.
Doctors from all specialtiesare going in and doing
subscription-based care.
So they were in Denver as well,and so I really spent three days
with my community.
But that's a lot of.
What I do all day is talking toemployers, talking to benefits
advisors, talking to people whowant to change the way that they
acquire care, and so a lot ofit's just education interesting,
(04:50):
and how has your role evolvedover the years as the business
has grown?
Dr Andrew Greenland (04:54):
I mean, you're in a ceo capacity and
you've been doing this for 10plus years.
How has your role changed?
Dr Cristin Dickerson (05:01):
this was really a side gig for me.
I was a full-time radiologistuntil 2020.
And full-time as a physician ismore than full-time, as you
know.
So I did this kind of nightsand weekends and really had to
subsidize it by being afull-time radiologist.
When it became clear we weregoing to be able to do this
(05:22):
nationally in 2020 and COVIDcame around and you know, the
world kind of changed.
I decided I was going to takethe leap and be full time with
green imaging, and so that'swhen I really, you know, had the
time to get out and starttraveling and go to these
conferences and educate people.
And you know I'm on Zoom callsall day and talking to benefits
(05:46):
advisors and.
HR directors for companies andCFOs of companies and talking,
you know, educating them about adifferent way to acquire health
care for their employees.
Dr Andrew Greenland (05:58):
Fascinating .
What major shifts are youseeing in the medical imaging or
health care space moregenerally right now?
What major shifts are youseeing in the medical imaging or
healthcare space more generallyright now?
Dr Cristin Dickerson (06:05):
There are a lot.
There are a lot of economicfactors going on.
Number one the biggest concernfor everybody should be 65% of
Texans are delaying care or justnot getting care because they
can't afford it.
That's been going on for awhile, but that's up from about
40, 45, 50% a few years ago.
(06:26):
That is huge, and so I thinkthat's the biggest economic
force going on right now.
The other is that employers arepaying more than anybody on the
planet US employers to acquirehealthcare.
That's not getting better forpeople and they're not able to
touch that healthcare.
Their deductibles are so highthat by the time they pay their
(06:46):
premium they don't have moneyleft to pay for care.
And the dirty secret is theydon't have to do that and I'm
seeing employers all over thecountry actually able to provide
care at zero out of pocket fortheir employees and still save
money from what they werespending with the traditional
networks.
And in imaging specifically, itis the private equity
(07:09):
acquisition of imaging centersand radiology groups and the
result there several factorsthere Hospitals are having.
With the first factor Idiscussed, hospitals are having
to increase the price of theirimaging so they can try to get
to the health plan above thedeductible because patients
can't afford this debt.
(07:29):
You know they're collecting 26cents on the dollar from
patients.
Private equity acquisition ofimaging centers means a friend
of mine sold some centers inHouston to a large chain of
imaging centers.
He said his EBITDA tripledovernight.
What he could make from thecenter tripled overnight because
their contracted rates were somuch higher than his.
(07:50):
That also means that everybodywho hasn't met their deductible
when they go to that imagingcenter.
They used to have really fairprices.
They had their cash prices andtheir contracted rates.
Now when they go there they'regoing to have a surprise bill
because the rates have tripledovernight.
And then the acquisition ofradiology groups means that the
(08:11):
surprise bill that people usedto get in November, december
from the radiology group thatthey didn't know they were going
to get a bill from actually maybe as high as the facility bill
.
We're seeing the professionalfees have just dramatically same
reason.
They're aggregating contracts.
You know bigger groups cannegotiate and get more leverage
(08:31):
with the payers and so againthat surprise bill may be as
high as the bill for the scanitself.
Dr Andrew Greenland (08:41):
I guess your operation must look fairly
attractive to a private equitygroup.
Is this something you'd betrying to kind of avoid and hang
on to this yourself?
What's your kind of take onthis?
Dr Cristin Dickerson (08:50):
Yeah, I mean, you know there are
strategic, there are privateequity groups that are trying to
pull together solutions thatcan hold down costs and replace
the traditional system, that canhold down costs and replace the
traditional system.
That's not something I'minterested in right now.
We're 100% radiologist ownedand operated.
(09:11):
I own 90% of the company andwe're completely bootstrapped.
But at some point, thefinancial risk of that just
becomes overwhelming and ourneed to automate, our need to.
You know, ai is not and that'sanother point of discussion
always is AI and imaging, butyou know all of the things that
we need to do to automate, tostreamline this and hold down
(09:34):
cost.
Ultimately, costs are aninvestment and so, you know, at
some point I will need investors, but they got to be the right
kind of investors.
That's very clear, you know.
We've stayed clear of that fora long time, intentionally and
thinking about.
Dr Andrew Greenland (09:52):
You know your clients.
I mean, how have millennialsand Gen Z clients changed the
way you approach the patientexperience?
Dr Cristin Dickerson (09:59):
it's very interesting.
We feel like we have to takeclients in whatever
communication mode they want.
My mom wants wants to call, Iwant to email and my son wants
to text, and that's just the wayit is.
And so we have multimodalintake for imaging orders.
And you know it literally issome people just want, you know,
(10:20):
to talk to somebody who speakstheir language on the phone.
And we found that during COVIDour average phone call doubled
in length and fortunately ourvolume had decreased by 50%.
So we were able to accommodatethat.
But it's very interesting whenpeople are under healthcare
stress, they really want a realperson, and that even includes
(10:40):
that our web chat is made byreal people.
It's not bots, it's not AI, itis real people responding to
people.
So we feel like there are a lotof different ways and the
younger people, a lot of theentire process can be handled by
(11:01):
secure text.
So even our older peopleusually will receive a text on
their phone.
But a young person justbasically takes a snapshot of
their order and their benefitscard.
Uh, text, that term, mainnumber.
That starts the referralprocess and you know they'll
have a voucher on their phone.
Gives them the date and time ofthe exam, uh, the address of
(11:23):
the facility and any prep neededfor the exam and what's?
Dr Andrew Greenland (11:27):
what has green imaging had to do to adapt
to these kind of requirementsfrom your clients?
You've talked about variousmodes of communication,
particularly young peoplewanting texting, all these kind
of things.
Have you had to put things intoplace to cater for these
demands?
Dr Cristin Dickerson (11:43):
It's really cybersecurity.
That is what we're having toadapt to.
I can't tell you how many timesa day we get attempted
cybersecurity threats.
We are.
We we've been stuck to audited,stuck to type two, which is
even a higher level audited, notbecause we're a company that
(12:03):
size that should have to do that, but because we are aggregating
data of PHI and we feel aresponsibility to do that.
But because we are aggregatingdata, health, phi and we feel a
responsibility to do that.
And so you know it's really.
I think the expensive and thehard part of doing this is, you
know, being loose enough toaccept people communicating with
(12:23):
us in all different ways, buttight on the cybersecurity.
So that's really the challengethere.
Dr Andrew Greenland (12:30):
Got it, and do you see these generational
demands as temporary trends orpart of a broader, lasting
transformation in what you do?
Dr Cristin Dickerson (12:38):
I think it's a broader, lasting
transformation, although whenpeople are under again, when
people are under healthcarestress and they are, even if
they're having a screening study, having a screening mammogram
you know, the best day of theyear is when you get your normal
screening mammogram result.
So even if people are gettingminor what we consider minor
testing done, they're understress when they reach out to us
(13:00):
and so it's really keeping tome.
How do we communicatesuccinctly, in a frictionless
way and still have the warmththat human beings need?
And that, to me, is thechallenge.
I don't think people are goingto read the whole text anymore,
ever again.
(13:21):
They're never going to readprose.
But you know, I think thisproneness we have to everything
moving fast will continue.
But I still think in healthcarewe number one.
We have to restore trust inhealthcare.
It's gone away, and so whenpeople's employers put green
imaging in place, they're alwaysskeptical this is just a cost
(13:42):
containment something.
So we have to get past that.
We have to let them know we'rereal people who really care
about them and are really goingto take great care of them.
And so we have to.
We have to amp it, that pieceof it, up, so much to get past
the brevity that everybody wantsand needs.
Dr Andrew Greenland (14:01):
Thank you, and I'm thinking about the green
imaging as a business.
What's working really well foryou in the company from from
your perspective and your team'sperspective.
Dr Cristin Dickerson (14:11):
I really think it's that.
It's the human touch.
If you look at our Googlereviews, we have 4.8 Google
stars, despite the fact we'repracticing healthcare, which
does not always go perfectly,and I think if you look at those
and read them and see howappreciative people are, or they
call our concierge shop by nameover and over again, and I
(14:31):
think that's really thedifference.
You know you can use an app togo find an inexpensive place to
get imaging.
Now we're not.
We don't want to be thecheapest place to get imaging.
We want the imaging centers towant our patients.
We want them to take great careof our patients.
Open evenings and weekends forour patients.
When we have a large group in atightly geographically
(14:53):
aggregated area.
But you know, anybody can findan imaging center.
It's the piece on top of it,the being cared for and the not
having to hang on the phone foran hour to get an off and to get
your appointment taken care of.
Those are the things that Ithink really make a difference.
Dr Andrew Greenland (15:12):
Well, congratulations on achieving
those kind of reviews, becausethat's very powerful.
We all know the power of theGoogle review and, similarly,
what's been particularlyfrustrating or challenging in
what you do.
Dr Cristin Dickerson (15:22):
It's the variation in how claims are
processed.
I mean, every doctor on theplanet understands this.
You know the billing issues wedid.
Originally we just did invoicesto our employers and to our
TPAs, but it became clear toscale we had to do EDI, which is
, you know, the electronic waythat claims are processed in
(15:45):
this country, and you know weare not contracted with who we
call the BUCAs the Blue Cross,Blue Shield, United, Cigna,
Aetna plans, intentionally.
That's just that didn't work inmy old life, I hated it, and so
you know we're not contractedwith those.
But the independent TPAs are aschallenged or have as difficult
(16:08):
a time processing claimscorrectly as the larger ones do,
and so I think the realfrustration has been again, just
like in a traditional practice,it's getting paid.
Dr Andrew Greenland (16:24):
And from another sort of business
perspective.
I guess there are a number ofmetrics that you're particularly
interested in.
Can you tell us a little bitabout the kind of things that
you pay particular attention toand perhaps the things that
you're most interested inimproving?
Dr Cristin Dickerson (16:37):
Yeah, you know.
Number one is our net promoterscore.
You know how we're doing withpatients.
How would patients recommend usto friends and family?
And that's first and foremostUm o are.
You know how quickl you knowaccess to care problem and how
(16:57):
quickly w scheduled Um can weget our preferred sites.
Do w sites that we've got greathat we're using on a dal.
Appreciate us, you know.
Help us hold down costs, takegreat care of our patients, hold
spots on Friday afternoon forus so that if we have a staff,
we can keep somebody out of theER.
(17:18):
Those are all things thatreally matter to us.
You know, from a financialstandpoint, you know obviously
there are metrics.
You know we've got to.
You know you can't have amission without a margin.
And obviously there are metrics.
You can't have a missionwithout a margin.
And so trying to keep the 10%margin going so that we can
(17:39):
continue to grow and take careof our employees is, of course,
critical for any medicalpractice and challenging.
And those are the things thatmatter.
Dr Andrew Greenland (17:51):
Brilliant and which are your biggest
bottlenecks right now in termsof what's going on in the
business?
Dr Cristin Dickerson (17:59):
I would say there's certain geographic
areas that are really, reallychallenging for us when they're
hospital dominant.
The Northeast is a challengefor us, geographically largely
hospital-based, They'vemaintained great reimbursement
with the payers because theirpatients are more spread out
(18:20):
geographically and there arevery few independent imaging
centers in those areas.
Boston has been a challenge forus.
Wisconsin has been a challengefor us.
It's really made.
Wisconsin has been a challengefor us.
It's geographies where it'schallenging to find facilities
for our patients.
Dr Andrew Greenland (18:39):
If you could wave a magic wand and fix
one thing in the businesstomorrow and we'll take billing
as a given, because that's akind of universal thing to North
America what would that thingbe?
Dr Cristin Dickerson (18:50):
Chaos, the dramatic variations in how
health care is provided.
I saw a statistic yesterday, orI heard a statistic yesterday,
that it's not just what it'scosting employers directly to
provide health care for theiremployees.
It is the time their employeeshave to spend away from work to
(19:18):
acquire health care.
There's a second cost and thatis how much time they have to
spend acquiring health care inthe current system, and it's all
because of the chaos and thebarriers that are put in front
of patients to acquire care.
Dr Andrew Greenland (19:31):
Interesting .
Maybe talk about growth in amoment, but I was going to ask
if you had a sudden influx ofnew leads or clients.
Obviously a nice problem tohave, but what would break first
in your system?
Dr Cristin Dickerson (19:45):
What would break first?
Probably geography.
What would break first?
Probably geography, and we dohave a huge influx coming in for
the end of this year and thebeginning of next year.
The challenge is geographicbuild out of the network and not
just geographic build out.
Our original model where we readthe studies is the best because
(20:06):
we control the images and thereports.
And access to images andreports is a problem for doctors
across the country.
Getting, getting you knowreports, auto fax to them.
They don't come a lot of thetime.
Even if you look at a doctor'sprescription pad, a lot of times
the fax number that's on thereis not the one where they really
(20:27):
want the reports going and itgoes into a dark hole.
And so access to images andreports is a challenge.
And so really, our getting backto our original model where we
read the most of the studies iscritical for us and a limiting
factor, and we'll get there.
(20:48):
It's just to get big and tohave enough facilities to do
this nationally.
We had to serve as more of atraditional network, even though
it's still our radiologists whoare protocoling the exams, even
though it's still ourradiologists who are protocoling
the exams.
It's our radiologists who are.
You know, if there's ever aquestion of quality, we're going
in there and looking at it.
We're reading about 43% of theexams right now and we need to
(21:10):
get back up to, you know, 75probably is realistic and
control those images and reports.
Dr Andrew Greenland (21:17):
And that is , you know, what keeps things
slick and moving nicely is therea creative fix for this
geography problem that you'veyou've mentioned, or are you
just really stuck with where,where things are in in space?
I'm just trying to get a senseof what the what, the creative
solution for this is well, Ithink hospitals are starting to
listen to us.
Dr Cristin Dickerson (21:37):
we're starting to have a really good
value prop for hospitals.
When I built this, I you know Ihad five imaging centers and so
I know their pain points,including hospitals.
You know we provide cleanradiologists protocol orders.
We there's no authorverification on their part.
(21:57):
We pay their fair price and wepay them promptly and so we
answer a lot of the pain pointsand for hospitals right now it's
trying to collect from patients.
So if I can get the rightperson at a hospital, I can
usually convince them to workwith us and we've done that.
We have some really greatrelationships in Texas now with
hospitals.
We have Baptists in San Antonio, we have Ascension in in Waco,
(22:20):
we're about to work withAscension in Temple and we work
with Oak Bend in Richmond, texas.
We really are starting to getthose relationships rolling.
I think that will solve ourproblem down the line.
It's getting to the rightperson at the hospital and
they're having open ears.
But if I get to them I canconvince them that this is a
better way to do things.
Dr Andrew Greenland (22:42):
I mean, you've been doing this about 10
years now, and so if you werestarting your business again
tomorrow, what would you dodifferently with everything that
you know and everything thatyou've been through?
Dr Cristin Dickerson (22:50):
Gosh, I don't know.
Resilience is such a it sodrives doing things better that
I don't know that I'd tradeanything or do anything
differently.
It really did take walking thispath and really learning the
mechanics.
I guess I would have learnedthe mechanics of healthcare
(23:11):
better, of how healthcarepayment systems work, how
third-party administrators work,how stop-loss works, the
catastrophic coverage thatemployers put behind their plans
.
I think I've probably I havebecome a benefits advisor, just
in self-defense and I probablywould have done that Now.
I was actually a managingpartner of a big multi-specialty
(23:33):
group early in my career, so Ialready knew the traditional
system pretty well.
But it's really once you getinto the mechanics of an
individual health plan where,had I had that knowledge earlier
, we would have averted someproblems.
Dr Andrew Greenland (23:52):
Thank you.
It sounds like you run a fairlystreamlined operation, but are
there anywhere areas that youfeel like you're perhaps behind
the curve?
I don't know whether aspects oftechnology, operations or
marketing.
Is there anything that you feelthat you have to catch up on?
Dr Cristin Dickerson (24:06):
You know, if any, I would say automation.
Except we're very cautiousthere.
You know, one of the thingswe're learning kind of the first
round of radiology AI hasfailed and I was very skeptical
about going into theinterpretive part of AI.
We have no investment therebecause we've all been through
the computer aided detection.
(24:27):
You know Medicare's paidbillions of dollars for
mammography computer aideddetection that does nothing more
than an experienced radiologistcan do and so I've gone into
that very skeptically.
Now we have used AI where wecan't nothing patient facing,
but we've used it.
I use it to organize myradiology report so I never have
(24:49):
to take my eyes off of theimages I can dictate and it puts
it in the proper order.
Of course I oversee that, but Iuse that to add.
It adds maybe 15 percentefficiency and time to my work.
But the hassle factor and Ithink my ability to interpret
(25:09):
and not be interrupted, nevertaking my eyes off to go make
sure I'm in the right place onthe report is really really
helpful.
Even if it didn't add theefficiency, I think I would use
it for that reason.
So I'm you know we're watchingvery carefully.
Now I do know that when weapplied for our malpractice this
(25:29):
year.
They were going to ding us forusing any interpretive AI.
We were going to have a higherrate because they're
experiencing malpractice issueswith some of these.
So I think I'm not going to saywe're behind the curve on that.
We're watching it veryskeptically and we will jump in
(25:50):
when we find solutions that wethink really benefit ourselves
as physicians and our patientsGot it.
Dr Andrew Greenland (25:58):
As CEO.
What keeps you up at night whenit comes to the future of green
imaging?
Maybe nothing, but I justwondered if there's anything
that kind of stirs you in yoursleep as a manager in your
business.
Dr Cristin Dickerson (26:10):
Sure, growing too fast and not being
able to take care of peopleoptimally, that's my fear and
there's a lot of interest inwhat we're doing right now and
you know we're just having to.
I mean, you know, kind of evengoing to this conference was a.
You know we had so much influxof people interested in new
(26:30):
business and we pretty much haveour channels full for next year
.
So you know it's how do webalance that?
Keep people interested andoptimistic for change, but scale
it smartly, intelligentlyintelligently?
Dr Andrew Greenland (26:51):
I hear you.
What about the future?
So where would you like greenimaging to be in six to 12
months time?
Is it around the growth thing,or are there other things that
you've kind of got your eye onfor the future.
Dr Cristin Dickerson (27:01):
For me it would be getting patients
through the pipeline as morequickly you know being and being
able to really um take on.
You know we've had about 30growth year over year in um in
patient care and being able toadd 50, 70 and so we can help
(27:21):
more people would would belovely wonderful.
Dr Andrew Greenland (27:26):
Kristin, thank you so much for your time
this afternoon.
It's been a really interestingconversation hearing about what
you and what you do at Green,imaging the model that you have
and how it's so different fromwhat other people are doing, and
your very honest and informeddescription of how you do your
thing.
It's really really interesting.
So thank you so much for yourtime, really really appreciate
it and I'm sure other peoplewill be interested to hear what
(27:48):
you have to say, and we'll putyour contact details on the bio
page of the podcast so anybodywho wants to get in touch or
find out more will be able to doso.
But thank you very muchfantastic thanks for having me.
Dr Cristin Dickerson (28:01):
Thank you.
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