October 9, 2025 • 31 mins
In this episode of Relentless Health Value, Stacey Richter talks mission with Dan Greenleaf, CEO of Duly Health and Care. Next week we cover margin. The discussion delves into the crucial balance between mission and margin in healthcare, highlighting how focusing on mission can drive financial stability.
The interview centers around four key quadrants of Duly's mission: affordability, access, consumer experience, and quality. Greenleaf emphasizes how these elements are interconnected and essential for providing better healthcare outcomes and financial viability.
The episode is part of a series exploring the mission/margin dynamic in the healthcare industry, and sets the stage for a deeper dive into how mission-focused strategies can result in decent margins in next week's episode.
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08:32 What should mission be in multispecialty?
08:54 Are mission and margin mutually exclusive?
10:47 What are the four “vectors” of Dan’s mission?
11:32 Why does affordability matter?
12:11 EP466 with Vivian Ho, PhD.
12:40 EP488 with Mark Cuban and Cora Opsahl.
13:32 Who are the three payers in the marketplace?
17:31 EP388 with Merrill Goozner.
19:19 How does access play into mission?
20:28 EP464 with Al Lewis.
21:07 EP467 with Stacey.
22:56 Why price transparency is important to consumer experience.
24:16 LinkedIn post from Patrick Moore.
29:06 EP481 with Benjamin Schwartz, MD, MBA.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Stacey Richter (00:01):
Episode 489 Part One, "Achieving Mission, That Is a Path to
Margin at a Multi-Specialty Practice".
Today I speak with Dan Greenleaf.
Tom Nash (00:20):
American Healthcare Entrepreneurs and Executives
You Want to Know, Talking.
Relentlessly Seeking Value.
Stacey Richter (2) (00:28):
This show today is a continuation of our mission
slash margin series because I wantedto drag into my investigation here
what clinical organizations are upto, especially ones that have brought
in professional capital as they say.
Before I kick in here, let me justremind everyone of a few themes
(00:50):
that we have been poking in theeyeballs in the past few months over
here at Relentless Health Value.
First, patients cannot afford care.
Listen to the show with MarkCuban and Cora Opsahl mentioning
middle class wage stagnation.
Listen to the show with Merrill Goozner.
Listen to the show with Wayne Jenkins, MD.
It is a crapshoot to getmedical care these days.
(01:12):
Roll the dice and hope you don'tget a bankrupting bill at the end.
There's no transparency orvery little for patients.
No accountability or interest from many.
Not all, but many take noresponsibility for their financial
impact on their patients or members.
And look, I am in no way speakingfor the vast majority of doctors or
nurses or pharmacists or PAs or evenreally good administrators or anybody
(01:34):
else involved in clinical care.
In fact, if you listen to the show withDr. Komal Bajaj about how many clinicians
do not actually trust their leadershipwill do right by patients or even
the clinicians themselves, then yeah.
This is undeniably the broad strokeof this industry we all work in.
Many take no responsibilityfor their financial impact
on their patients or members.
(01:55):
That is the first theme.
Here's the second theme.
It's this motto, If you can takeit, take as much as you can get.
And throw in no shade, butlet's just get real about that.
Right now healthcare is an industryjust like any other industry.
And when I say industry, Imean the tax exempt so-called
nonprofits as much as anybody else.
Said another way, corporatehealthcare leaders, just like any
(02:17):
other business leaders have everyincentive to see prices go up.
That is just the way commerce works.
Listen to the show with JonathanBaron, the ones with Kevin Lyons.
But what is different than most othercommerce endeavors when it comes to
healthcare, and Shane Cerrone fromKada says this in an upcoming episode,
he says, "We don't have a brokenhealthcare market. In many parts of
(02:41):
the country, there is no healthcaremarket. The market does not exist".
And thus prices can go up like rocketships because self-insured employers
and also public plan sponsors a lot oftimes, like state health plans are on the
whole just such unsophisticated buyers,price elasticity is like non-existent.
(03:02):
No matter how high the price, plansponsors still contract for who's
ever in the network and they and theirmembers ante up and pay the price.
Many good and maybe not so good reasonsfor this, not getting into them, but
net net, the result is a non-market.
Anyone who wants to debate my corporatehealthcare entities or big consolidated
healthcare entities act just like anyother corporate entity, read the Substack
(03:25):
by Preston Alexander from last week.
Link in the show notes.
It's about hospitalsraising capital with bonds.
Preston Alexander wrote, "The financialdesign of the system has turned
what should be a largely altruisticservice, one designed for public good
and societal benefit, and forced itto act like a financial institution".
And so with those bonds,welcome Wall Street.
(03:47):
What do Wall Street bankersthink about patient care and
access and community health?
Oh, they don't thinkabout those things at all.
Municipal bond returns, baby.
That's it.
Bonds are an investment where peoplewho invest in them, returns are
expected just like shareholderswho want their dividends.
Preston Alexander wrote, "Most largerhealth systems carry billions (That was
(04:08):
a B back there) in bond liabilities".
It costs money to build buildingsand add beds and consolidate yo,
but now they are subject to the samepressures as publicly traded companies.
So then I got my hands onDan Greenleaf, CEO of Duly, a
multi-specialty group in Chicago.
I was absolutely intrigued fromthe starting gate because Dan told
(04:30):
me that mission can actually begetmargin in his view, and he even at
Duly, has private equity investors.
So yeah, I was all ears.
Dan Greenleaf, who is my guest today, bythe way, if you haven't figured that out,
told me that because of but not limitedto the trends above wildly high prices,
(04:51):
high premiums, high deductibles, moreconsolidation, fewer options, scared,
confused, and maybe outraged patients.
Listened to the show with Peter Hayes.
Dan said that given this backdrop,actually focusing on mission is
a huge competitive advantage.
Justina Lehman actually also saidthis in a show from a few years ago.
Dan told me, Dan Greenleaf, whenyou succeed at mission, you can get
(05:13):
yourself decent margin these days.
Dr. Vivian Ho (05:16):
Hi, I am Dr. Vivian Ho.
I'm a health economist at RiceUniversity in Baylor College of Medicine.
I listen to Relentless Health Valuereligiously because this is the
show for those who are part of thetribe that wants to improve the
quality of healthcare, improve accessto care, and make it affordable.
So make sure that you subscribe tothe newsletter and subscribe to the
(05:39):
podcast and keep up with every episode.
Stacey Richter (2) (05:43):
So in this first episode, we will talk about this mission
of which Dan Greenleaf speaks, and thenin part two coming at you next week,
we'll get into how that all spells margin.
Here's what I thought was superimportant about this whole mission margin
conversation, and Mick Connors, Dr.Mick Connors in a show coming up also
touches on this, to achieve mission, youreally have to define what mission means.
(06:10):
Dr. Ben Schwartz said this too in somany words in the show from last summer.
And that doesn't mean just have agloriously well-written webpage,
and you just can't have spreadsheetsof random quality metrics either.
You have to treat the mission likeyou treat any strategic imperative.
You gotta break it down and figureout how you're gonna measure
what you're actually doing.
(06:31):
Rik Renard talked about this one too.
At Duly, which Dan Greenleaf talksabout in this episode, the focus is
on four quadrants of mission (06:37):
one, affordability; two, access; three,
consumer experience and four; quality.
In this conversation, Dan emphasizesthat achieving these four quadrants
reduces friction for patients andclinicians and leads to better care
outcomes and financial stability.
(06:57):
To be noted with one big fatfluorescent highlighter marker is this.
A big part of this mission, in almosteach of these quadrants is about making
prices reasonable and predictableand transparent for patients.
In today's world, that's what customerexperience, must include not just
like lemon water in the waiting room.
(07:18):
That struck me the most.
And all this focus on affordabilityreally adds up across the community.
In Chicago, lower costalternatives to hospital services
can save up to $2 billion.
That is also with a B. And thecommunities are also healthier.
Crazy.
Hey, make sure patients andmembers can afford and have
access to quality healthcare andthe community gets healthier.
(07:40):
Who would've thought?
Dan Greenleaf, CEO of Duly, my guesttoday has been in healthcare for 30 years.
My name is Stacey Richter.
This podcast is sponsored by AventriaHealth Group, but I do just wanna mention
that Duly so kindly offered RelentlessHealth Value, some financial support,
which we truly, truly appreciate.
So call this episode alsosponsored with an assist by Duly.
(08:03):
Here's my conversation with DanGreenleaf and do come back next week
for part two like I said earlier.
Today, we talk mission.
Next week we talk margin.
Dan Greenleaf, welcome toRelentless Health Value.
Dan Greenleaf (08:13):
Thank you, Stacey, for having me.
Super excited to be talking to you today,and I think you do an unbelievable job.
I mean, your podcasts are just incredible.
Thank you for everything you're doing.
Stacey Richter (08:25):
Well, I very much appreciate you saying that, those kind
words, and I also very much appreciatethe opportunity to speak with you today.
So before we kick into this continuationof our mission slash margin series
from the independent multispecialtypractice point of view, if we're
thinking about what is possiblewhen an independent multispecialty
(08:48):
group lives up to their potential,let's start talking about mission.
Dan Greenleaf (08:53):
To me, and again, we talk about margin versus mission, I don't
ever think they're mutually exclusive.
My job, I think, fundamentallythere's two things.
One is to reduce friction for the patient.
And the second thing is how do I reducefriction for the clinicians who care
for them so that we can create thatsacred space that the two parties
(09:16):
come together in the most optimal way.
That's when I wake up and that'swhat I think about every day.
So, and I think the byproduct ofthat is obviously margin that we're
able to reinvest back in the company.
Stacey Richter (09:28):
Lemme just interject because I just kind of wanna
underline what you said there.
If you do mission very well, that can bea multiplier for margin, you're not saying
that this is some kind of zero sum gamethat like for every two points of mission,
you subtract two points of margin.
What you're actually saying is ifyou're creative, you could also view
mission as a way to accelerate andto be competitively differentiated.
Dan Greenleaf (09:53):
Think about this, like I think there's three people who make
decisions to do something when they're 18.
One is, I would say the priesthood.
The second one is peoplewho go in the military.
And the third one is, I thinkpeople that serve people through
being a clinical care person.
And the point of bringing this up is thatthese individuals made vocational choices.
(10:16):
And they did this because Idescribe it as a soul calling.
It was a soulful decision, andpart of my job is to make sure I'm
helping bring that out every day.
I really feel very responsible aboutand how do I make their job easier
so that they can care for morepatients so that they can bring the
best of who they are when they'reinteracting with the patients.
(10:40):
And that that can be a forcemultiplier for the organization.
So again, it goes back to this missionand margin work very well together.
Stacey Richter (10:47):
And you have four categories or four vectors of your mission
when it comes to Duly, which is themulti-specialty group that you're running.
Why don't we just tee upwhat those four vectors are?
And then I will go back andask you each one individually.
Dan Greenleaf (11:08):
In the four are, affordability, access,
consumer experience, and quality.
Stacey Richter (11:13):
Affordability, access, consumer experience, and quality.
So if I ask you to define mission,those are the four factors that
you would say comprise mission.
Which is really interesting becauseoftentimes we talk about mission and is
this vague, unmeasurable vis-a-vis, notjust quant, but no one, not even qual.
Let's start with improve affordability.
(11:35):
And as we all know, there's financialtoxicity that's out there, so being
able to afford care has certainlygotten much more important lately,
but what do you mean by affordabilityas one of your mission quadrant?
Dan Greenleaf (11:46):
I gotta start high here, Stacey, and talk about some macro
factors first so I can make a lot ofsense in why affordability matters
and some of this has comes from, youknow, some of the work Vivian Ho does.
So number one, we know over thelast 20 years, inflation is up 61%.
Wages are up, one 11, premiums are three14, and family responsibilities 326.
Stacey Richter (12:11):
Vivian Ho goes through all these stats and what they
all mean in a really stunning way.
Actually, in that episodelink in the show notes.
But you talked about how inflationis up a fraction, a fraction of the
rise in premiums and in out-of-pocketcosts for families for healthcare.
While meanwhile, wages areup a fraction of inflation.
So in real terms, the middle classis making less money than they used
(12:34):
to and materially less when you alsofactor in the cost of healthcare
getting taken out of their paychecks.
Mark Cuban actually talked about thisa lot, and he called the amount getting
taken out of paychecks, another tax, whichis actually a bigger tax than the tax.
Dan Greenleaf (12:48):
The actual dollars at families now are spending from 2000 to
2024 has gone from 6,000 to $24,000.
The average American makes $74,000 a year.
So when you think about like, wherethe financial discrimination is
occurring is unequivocally in themiddle class and lower classes, you
(13:10):
know, for lack a better description.
And it, it's disgraceful.
It's disgraceful to me that we'vedecided as a country that we're
gonna put the onus of these extremeincreases in care on the middle class.
So, I just wanna start there that thisis this is the lens I look through.
The second thing is I wanna point outis that there are three payers and
(13:34):
only three payers in the marketplace.
There's the taxpayers, there'sthe employers and the unions.
Everybody else is a middle person.
And so as I orient myself and orientmyself to discussions, those are the
three groups I focus on and I also wantyou all to know that I'm spending $85
million myself as a self insured employer.
(13:56):
So we're not only providing the care, butwe're also taking on that responsibility
of like making sure that we're notgetting disproportionately harmed by the
way the healthcare system's been set up.
So starting there, and that's againthe lens I look through, Stacey.
Stacey Richter (14:13):
We talk about this a lot on this pod.
The ones, the only ones footingthe healthcare bill are taxpayers,
employers, unions, and patientsthemselves increasingly.
So I'd put them on the end here.
How does all of this funnel intoyour affordability mission quadrant?
Dan Greenleaf (14:31):
So, if I think about affordability, and you and I
have talked about the MRI example,we do, we have 400 MRIs a day.
Think about this from, if thepatient was go to a hospital system
in Chicago, they're paying $4,500.
They come to Duly, it's $500.
That is 400, $400 million thatwe save the healthcare system
(14:55):
on just that service alone.
Colonoscopies.
We do 22,000 colonoscopies.
They are approximately $10,000less than it costs to have the
similar service done in a hospital.
That's another 220 million dollars.
And then you start looking at things justlike tummy tucks, $8,500 versus $70,000.
(15:19):
Knee replacements, $8,500 versus 65,000.
Hip replacements, $8,500 versus $50,000.
And what also gets missedin this discussion is the
patient responsibility piece.
So this co-insurance.
So something simple like an MRI,$4,500, 20% co-insurance is $900 to
(15:45):
that family versus a hundred dollars.
So that's an $800 difference.
And so Duly brings a level ofaffordability to Chicago marketplace.
You know, we're saving theemployers, the unions, and in
some respects, the taxpayers, wellin excess of a billion dollars.
I think it's probablycloser to $2 billion.
(16:07):
So affordability really matters inthis day and age, and I'm really tired
of, you know, frankly, the middleclass, this financial discrimination
that occurs in the middle class is aresult of this lack of transparency.
So nobody understands what anythingcosts, and they think they're going
to the best place because maybeit has a brand attached to it.
(16:29):
And at the end of the day, theircompensation is being affected by that.
Stacey Richter (16:34):
Yeah.
And that's something that Dave Chasefor one, has talked about for years.
Just the stagnation of middle classwages being directly attributable to
the increase in the dollars that aregoing to the healthcare industry.
While at the same time, for example, thefederal poverty limit is being calculated
(16:57):
based on things that tend to rise at therate of inflation, like food or gasoline.
Whereas you have this huge otherthat a huge proportion of wages right
now are going into the healthcareindustry that is rising at a
wildly high rate above inflation.
So I've just started to see callslately, which basically say we have
(17:19):
to change all this because to yourexact point, you know there, there's a
reason why 61% of Americans, I believe,have said that they are dealing or
foregoing care due to fear of cost.
We had Merrill Goozner onwho gave a great example.
He's like, what is this spot on my arm?
Is it melanoma?
I don't know.
But I do know that's gonna cost me$600 to go to the doctor to find out.
(17:40):
So I'm just gonna wait and see, I guess.
You know, I have chest pain.
Am I gonna go to the doctor?
I wanna think real hard about that'cause I don't wanna bankrupt my family.
Dan Greenleaf (17:47):
And you look at the culprits in this, Stacey, the
hospitals have increased at 256%over that same period of time.
So all this consolidation that's occurredhasn't driven quality, hasn't driven
access, hasn't driven affordability.
All it's done is raise prices andat at that same period of time.
If you look at physician comp andadjust for inflation, and I think
(18:11):
you know this, it's down 36%.
So the folks that are actuallyproviding the care are the ones
that are getting penalized.
Stacey Richter (18:19):
I think that we have made a very compelling
rationale for why focusing onaffordability really matters here.
And we are talking aboutmission and I don't wanna, I
don't wanna go off track here.
Um, we will talk about margin andobviously, foreshadowing to the max, but
I'm gonna ask you, how can you afford todo an MRI for $450 and still make money
(18:42):
when the hospital down the street ischarging 4,500, very unapologetically.
Right.
Or all the things that you just mentioned.
But what we're taking away from thismission is that it actually really is
very mission focused to try to figure outhow to charge a fair price for services
rendered, especially because of thepatient affordability bit here and the
(19:06):
fact that patients are paying 20% orhave these high deductibles or whatever.
So if we're concerned aboutpatient health, making care,
affordable really matters.
It's not some kind of like, you know,off to the side secondary consideration.
Which leads, I think very, itwas a lovely segue into access.
The second thing that you mentioned,how is that part of your mission?
Dan Greenleaf (19:26):
Yeah, I mean, on average our access is two days.
So if you have an appointment with usand you have a follow on appointment,
for example, it's two days and thehospitals in Chicago are between
eight and 60 days, and on averageyou get into see us 20 days sooner.
And I have an example of somebody on myteam, a young lady in her twenties that
(19:50):
got diagnosed with colon cancer and thenwas told she wouldn't be able to see,
have a follow on appointment for 60 days.
So this stuff is real.
And fortunately she knew somebodyand she could make a call, but
not everybody knows somebody.
Could you imagine getting adiagnosis for cancer and say,
Hey, we'll see you in 60 days.
(20:10):
Do you imagine what that would belike, you know, for the next 60 days?
And so this matters.
This matters a lot.
Stacey Richter (20:17):
This also goes back to the affordability component,
a quadrant of your mission.
Because what winds up happeningwhen patients don't have access?
I'll tell you what happensbecause this is proven.
Listen to the show about emergency rooms.
What winds up happening is that thosepatients then wind up in the emergency
room, which winds up costing everybody alot, therefore diminishing affordability.
(20:38):
So these are not unrelated aspects here.
Dan Greenleaf (20:41):
And we, it's so good.
We just did an Avalere study just onMedicare fee for service, and we were
25% less expensive in the hospitals.
But interestingly enough, 15%fewer hospital admins in 13%.
Fewer ER admins.
So you're absolutely right that accessand affordability drives lower cost.
Stacey Richter (21:07):
Yeah, there was a show called the, I think it's called
like Primary Care and Emergency Roomthrough Line Show, where basically
I cited about 90 stats, whichvalidate exactly what you're saying.
All right.
Your third one, again, not unrelated here.
These are all kind of a, yeah, youcan start to see how they all fit
together is consumer experience.
Dan Greenleaf (21:28):
So we, we partnered with Press Ganey and we do approximately,
you know, I don't know how manysurveys we actually do, but we get
50,000 responses on a quarterly basis.
And we use that to gaugeour net promoter score.
Net promoter scores are very familiarway to measure consumer experience.
(21:51):
Our net promoter score is 74.
Anything above a 70 is world class.
And so who's in that category with you?
It's all these kind ofamazing global brands.
So think Amazon, thinkStarbucks, think Netflix.
Hospitals on the other hand, their averagenet promoter score nationwide is 46.
(22:13):
And so again, from a consumer experiencestandpoint, we are far superior in
the other entities in the marketplacewhen it comes to consumer experience.
Stacey Richter (22:23):
There's a difference between hospitals and clinicians
who work at hospitals, and I thinkthat's really important to point out.
Like if you are talking about aspecific nurse or a specific doctor,
the level of trust in those individualsis generally speaking, rightfully
so, most of the time very high.
But if we're talking about theorganization of the hospital itself.
(22:46):
And again, not throwing everybodyin the same blanket category here,
because there are hospitals and thenthere are these consolidated health
systems that are very, very different.
But if you start looking at the patientexperience from beginning to end, like
after they got their bill, which was $700higher than they thought it was gonna be,
or after they couldn't figure out how toget an appointment or after they had a
(23:08):
question and no one answered it, that'swhat you're talking about here where
the overall net promoter score for theorganization itself can be shockingly low.
And the thing that a patient isgoing to be considering as they're
considering their care and whetherthey wanna do the follow up, this
definitely has clinical relevance also.
Dan Greenleaf (23:31):
I just wanna bring up, you know, we save these families of
four an average of seven to $14,000.
And one of the things that we're nowdoing is we're educating the consumer.
We're telling the consumer by comingto us and by getting care from us,
not only are you gonna have a superiorconsumer experience, but you're also
(23:53):
going to understand how much things cost.
And we're gonna continue to do that.
Stacey Richter (23:58):
Okay?
So this is another point ofintersection in these mission quadrants.
If you are less expensive, then howyou make that into a competitive
advantage, especially with patientsthese days, even if their employer is
unconcerned about it and frightfully,many C-suites are wildly unconcerned.
I'll link to a post Patrick Moore put inLinkedIn the other day that was shocking.
(24:20):
But if your prices are reasonable, thenyou can be transparent about said prices
and educate patients on how much saferyou are from a financial standpoint.
You told me before that you put posterson the walls talking about prices.
And I really just wanna point out thefundamental difference in the calculus
that's happening here for consumerexperience then one normally hears.
(24:44):
So if you are in a room of executivesand someone starts talking about
consumer experience, what oftengets brought up is like, is there
lemon water in the waiting room?
But if we're really thinkingabout what matters in the consumer
experience continuum, it's goingto be stuff like bankrupting
financial bombshell on the backend.
The more effort put into financialtransparency, the better the patient
(25:05):
experience because they have somecertainty about what is gonna
happen with their financial future,which is very anxiety provoking.
So we're saying that transparency is partof the consumer experience, and then just
the affordability, you said seven to 14kless also part of the consumer experience.
Alright, we started out with fourquadrants of what mission means.
We talked about affordability,we talked about access, we
(25:27):
talked about consumer experience.
Lastly, we've got quality here.
And I think one of the things alsothat's just becoming very clear is how
intertwined all of these things are.
But let's, let's talkspecific quality now.
Dan Greenleaf (25:40):
We've got many examples, but these are three examples
that I think are very relevant.
So we do a fair amountof prostate screening.
We biopsy the patient, you know, there's asurface antigen or whatever the tests are.
But in 77% of the time thatwe do a biopsy, it's positive.
The national average is 25%.
(26:03):
Think about that in terms of like theamount of waste and biopsies that are
being done at the expense of the patient.
And the fact that Duly does itright, 77% of the time the national
average is 25% is remarkable.
The second one I like to point out isthat hips and knees, not only do we look
(26:25):
at quality outcomes, which are terrific,but we also get feedback from the patient.
We're interested in likethe patient experience.
What's it been like, what's patientreported outcomes look like?
And in hips and knees we arewell above the national average.
In fact, you know, we've done sucha good job here that we're gonna
expand in the spine and pain.
(26:45):
So patient reported outcomes.
The last one is, is I'll justshare with you and there's
many more, is lung screening.
And what we do on the lung screeningside is we do a lot of outbound calls,
like it's kind of inconvenient andwe don't get paid for outbound calls.
Not that it matters, but we catch thepatient stage one or two and not three and
(27:05):
four, and we've been doing this for years.
We have detected hundredsof early stage lung cancers.
So it's not just about affordabilityand about access and about consumer
experience, but our quality.
And you know, we've got otherexamples of activation campaigns
that we do, and our activationcampaigns are with existing patients.
(27:30):
They focus on things like colonoscopies,mammograms, wellness visits, diabetic
screenings, but we've got some remarkablestories of where we've detected breast
cancer and I don't know how many casesand when the person wasn't aware of it.
And in one instance, I mean, weliterally, you know, from the time
that SMS message went out to time, theygot put on therapy, it was 25 days.
(27:55):
And I'm just tellingnobody does it like that.
So we're, we're just doing alot of stuff in this area and we
really, it's in our clinical DNA.
Stacey Richter (28:03):
And I really just want to underline this because we're
kind of talking about this like it'sa given and I really just wanna point
out how much it's not because youdo not run across very many groups
in general of clinical organizationswhere you can say, define your mission,
and they can come back and say, itis comprised of these four components
(28:26):
in the way that you are doing here.
Where very focused on affordability,access, consumer experience, and quality
like that is very much how we're definingmission, which is really a huge reason
why I was so excited to have you on theshow because it is actually so unusual.
Dan Greenleaf (28:42):
You know, I'll also point out like, you know, they did these
healthy community evaluations and in onecommunity page we see 40 to 50% of all
the patients there, and that community'sranked one of the highest from a healthy
perspective communities in the country.
So what we're doing, and again,not all zip codes are the same.
(29:03):
We know that, but at least in the oneswe're in, we're making a difference.
Stacey Richter (29:06):
This really ties to an episode with Dr. Ben Schwartz, where
he says something about understandingyour return on mission and also an
upcoming episode with Shane Ceroneand Sam Flanders from Kada Health.
And they say something fascinatingabout aligning incentives so that the
hospital's goals are consistent withdelivering value to the community rather
(29:28):
than just increasing volume or prices.
I mean, it's just so fundamentaland so not status quo.
So Dan Greenleaf, if someone is interestedin learning more about Duly, if they are
in the Chicago area, especially if they'rea plan sponsor, if I'm picking up what
(29:49):
you're putting down correctly, where wouldyou direct them for more information?
Dan Greenleaf (29:53):
Yeah, I think you can go to our website, duly.com.
You can go to my LinkedIn page.
We publish a lot of things about theorganization and what we're doing,
and if people wanna reach out tome, it's dan.greenleaf @duly.com.
I'd be happy to talk withpeople who are involved here.
I've done something verysimilar I've shared with you.
I've reached out to a few people who I'veheard on the podcast, so I would certainly
(30:18):
wanna extend that invitation as well.
Stacey Richter (30:22):
Okay, so today we, meaning Dan Greenleaf and I talked
about mission, we talked about the fourquadrants of mission, affordability,
access, consumer experience, and quality.
Come back next week because what we'regonna talk about next week is how mission
and margin can really be complimentary.
(30:43):
And spoiler alert, a big piece of thatis making sure physicians and other
clinicians have a very real seat atthe table and even an ownership stake.
What Dan Greenleaf also talks about,and this is something that Shane
Sarone and Dr. Sam Flanders talk about,is just how important it is to do
cost accounting to really understandwhat efficiency actually means.
(31:07):
Then lastly, I definitely grill Dana little bit about what it is to
have a capital partner and when itcomes to capital partners, what the
mission margin balance looks like.
So that said, see you next week.
Tom Nash (31:22):
Hi, this is Tom Nash, one of the RHV team members.
You might recognize my voicefrom the podcast intro.
If you love the show and you wannashow us your support, please follow
us on your favorite podcast app.
Sign up for the newsletter,or maybe consider making a
small donation in the tip jar.
Thanks so much for listening.
Episode 489 Part One, "Achieving Mission, That Is a Path to
Margin at a Multi-Specialty Practice".
Today I speak with Dan Greenleaf.
Tom Nash (00:20):
American Healthcare Entrepreneurs and Executives
You Want to Know, Talking.
Relentlessly Seeking Value.
Stacey Richter (2) (00:28):
This show today is a continuation of our mission
slash margin series because I wantedto drag into my investigation here
what clinical organizations are upto, especially ones that have brought
in professional capital as they say.
Before I kick in here, let me justremind everyone of a few themes
(00:50):
that we have been poking in theeyeballs in the past few months over
here at Relentless Health Value.
First, patients cannot afford care.
Listen to the show with MarkCuban and Cora Opsahl mentioning
middle class wage stagnation.
Listen to the show with Merrill Goozner.
Listen to the show with Wayne Jenkins, MD.
It is a crapshoot to getmedical care these days.
(01:12):
Roll the dice and hope you don'tget a bankrupting bill at the end.
There's no transparency orvery little for patients.
No accountability or interest from many.
Not all, but many take noresponsibility for their financial
impact on their patients or members.
And look, I am in no way speakingfor the vast majority of doctors or
nurses or pharmacists or PAs or evenreally good administrators or anybody
(01:34):
else involved in clinical care.
In fact, if you listen to the show withDr. Komal Bajaj about how many clinicians
do not actually trust their leadershipwill do right by patients or even
the clinicians themselves, then yeah.
This is undeniably the broad strokeof this industry we all work in.
Many take no responsibilityfor their financial impact
on their patients or members.
(01:55):
That is the first theme.
Here's the second theme.
It's this motto, If you can takeit, take as much as you can get.
And throw in no shade, butlet's just get real about that.
Right now healthcare is an industryjust like any other industry.
And when I say industry, Imean the tax exempt so-called
nonprofits as much as anybody else.
Said another way, corporatehealthcare leaders, just like any
(02:17):
other business leaders have everyincentive to see prices go up.
That is just the way commerce works.
Listen to the show with JonathanBaron, the ones with Kevin Lyons.
But what is different than most othercommerce endeavors when it comes to
healthcare, and Shane Cerrone fromKada says this in an upcoming episode,
he says, "We don't have a brokenhealthcare market. In many parts of
(02:41):
the country, there is no healthcaremarket. The market does not exist".
And thus prices can go up like rocketships because self-insured employers
and also public plan sponsors a lot oftimes, like state health plans are on the
whole just such unsophisticated buyers,price elasticity is like non-existent.
(03:02):
No matter how high the price, plansponsors still contract for who's
ever in the network and they and theirmembers ante up and pay the price.
Many good and maybe not so good reasonsfor this, not getting into them, but
net net, the result is a non-market.
Anyone who wants to debate my corporatehealthcare entities or big consolidated
healthcare entities act just like anyother corporate entity, read the Substack
(03:25):
by Preston Alexander from last week.
Link in the show notes.
It's about hospitalsraising capital with bonds.
Preston Alexander wrote, "The financialdesign of the system has turned
what should be a largely altruisticservice, one designed for public good
and societal benefit, and forced itto act like a financial institution".
And so with those bonds,welcome Wall Street.
(03:47):
What do Wall Street bankersthink about patient care and
access and community health?
Oh, they don't thinkabout those things at all.
Municipal bond returns, baby.
That's it.
Bonds are an investment where peoplewho invest in them, returns are
expected just like shareholderswho want their dividends.
Preston Alexander wrote, "Most largerhealth systems carry billions (That was
(04:08):
a B back there) in bond liabilities".
It costs money to build buildingsand add beds and consolidate yo,
but now they are subject to the samepressures as publicly traded companies.
So then I got my hands onDan Greenleaf, CEO of Duly, a
multi-specialty group in Chicago.
I was absolutely intrigued fromthe starting gate because Dan told
(04:30):
me that mission can actually begetmargin in his view, and he even at
Duly, has private equity investors.
So yeah, I was all ears.
Dan Greenleaf, who is my guest today, bythe way, if you haven't figured that out,
told me that because of but not limitedto the trends above wildly high prices,
(04:51):
high premiums, high deductibles, moreconsolidation, fewer options, scared,
confused, and maybe outraged patients.
Listened to the show with Peter Hayes.
Dan said that given this backdrop,actually focusing on mission is
a huge competitive advantage.
Justina Lehman actually also saidthis in a show from a few years ago.
Dan told me, Dan Greenleaf, whenyou succeed at mission, you can get
(05:13):
yourself decent margin these days.
Dr. Vivian Ho (05:16):
Hi, I am Dr. Vivian Ho.
I'm a health economist at RiceUniversity in Baylor College of Medicine.
I listen to Relentless Health Valuereligiously because this is the
show for those who are part of thetribe that wants to improve the
quality of healthcare, improve accessto care, and make it affordable.
So make sure that you subscribe tothe newsletter and subscribe to the
(05:39):
podcast and keep up with every episode.
Stacey Richter (2) (05:43):
So in this first episode, we will talk about this mission
of which Dan Greenleaf speaks, and thenin part two coming at you next week,
we'll get into how that all spells margin.
Here's what I thought was superimportant about this whole mission margin
conversation, and Mick Connors, Dr.Mick Connors in a show coming up also
touches on this, to achieve mission, youreally have to define what mission means.
(06:10):
Dr. Ben Schwartz said this too in somany words in the show from last summer.
And that doesn't mean just have agloriously well-written webpage,
and you just can't have spreadsheetsof random quality metrics either.
You have to treat the mission likeyou treat any strategic imperative.
You gotta break it down and figureout how you're gonna measure
what you're actually doing.
(06:31):
Rik Renard talked about this one too.
At Duly, which Dan Greenleaf talksabout in this episode, the focus is
on four quadrants of mission (06:37):
one, affordability; two, access; three,
consumer experience and four; quality.
In this conversation, Dan emphasizesthat achieving these four quadrants
reduces friction for patients andclinicians and leads to better care
outcomes and financial stability.
(06:57):
To be noted with one big fatfluorescent highlighter marker is this.
A big part of this mission, in almosteach of these quadrants is about making
prices reasonable and predictableand transparent for patients.
In today's world, that's what customerexperience, must include not just
like lemon water in the waiting room.
(07:18):
That struck me the most.
And all this focus on affordabilityreally adds up across the community.
In Chicago, lower costalternatives to hospital services
can save up to $2 billion.
That is also with a B. And thecommunities are also healthier.
Crazy.
Hey, make sure patients andmembers can afford and have
access to quality healthcare andthe community gets healthier.
(07:40):
Who would've thought?
Dan Greenleaf, CEO of Duly, my guesttoday has been in healthcare for 30 years.
My name is Stacey Richter.
This podcast is sponsored by AventriaHealth Group, but I do just wanna mention
that Duly so kindly offered RelentlessHealth Value, some financial support,
which we truly, truly appreciate.
So call this episode alsosponsored with an assist by Duly.
(08:03):
Here's my conversation with DanGreenleaf and do come back next week
for part two like I said earlier.
Today, we talk mission.
Next week we talk margin.
Dan Greenleaf, welcome toRelentless Health Value.
Dan Greenleaf (08:13):
Thank you, Stacey, for having me.
Super excited to be talking to you today,and I think you do an unbelievable job.
I mean, your podcasts are just incredible.
Thank you for everything you're doing.
Stacey Richter (08:25):
Well, I very much appreciate you saying that, those kind
words, and I also very much appreciatethe opportunity to speak with you today.
So before we kick into this continuationof our mission slash margin series
from the independent multispecialtypractice point of view, if we're
thinking about what is possiblewhen an independent multispecialty
(08:48):
group lives up to their potential,let's start talking about mission.
Dan Greenleaf (08:53):
To me, and again, we talk about margin versus mission, I don't
ever think they're mutually exclusive.
My job, I think, fundamentallythere's two things.
One is to reduce friction for the patient.
And the second thing is how do I reducefriction for the clinicians who care
for them so that we can create thatsacred space that the two parties
(09:16):
come together in the most optimal way.
That's when I wake up and that'swhat I think about every day.
So, and I think the byproduct ofthat is obviously margin that we're
able to reinvest back in the company.
Stacey Richter (09:28):
Lemme just interject because I just kind of wanna
underline what you said there.
If you do mission very well, that can bea multiplier for margin, you're not saying
that this is some kind of zero sum gamethat like for every two points of mission,
you subtract two points of margin.
What you're actually saying is ifyou're creative, you could also view
mission as a way to accelerate andto be competitively differentiated.
Dan Greenleaf (09:53):
Think about this, like I think there's three people who make
decisions to do something when they're 18.
One is, I would say the priesthood.
The second one is peoplewho go in the military.
And the third one is, I thinkpeople that serve people through
being a clinical care person.
And the point of bringing this up is thatthese individuals made vocational choices.
(10:16):
And they did this because Idescribe it as a soul calling.
It was a soulful decision, andpart of my job is to make sure I'm
helping bring that out every day.
I really feel very responsible aboutand how do I make their job easier
so that they can care for morepatients so that they can bring the
best of who they are when they'reinteracting with the patients.
(10:40):
And that that can be a forcemultiplier for the organization.
So again, it goes back to this missionand margin work very well together.
Stacey Richter (10:47):
And you have four categories or four vectors of your mission
when it comes to Duly, which is themulti-specialty group that you're running.
Why don't we just tee upwhat those four vectors are?
And then I will go back andask you each one individually.
Dan Greenleaf (11:08):
In the four are, affordability, access,
consumer experience, and quality.
Stacey Richter (11:13):
Affordability, access, consumer experience, and quality.
So if I ask you to define mission,those are the four factors that
you would say comprise mission.
Which is really interesting becauseoftentimes we talk about mission and is
this vague, unmeasurable vis-a-vis, notjust quant, but no one, not even qual.
Let's start with improve affordability.
(11:35):
And as we all know, there's financialtoxicity that's out there, so being
able to afford care has certainlygotten much more important lately,
but what do you mean by affordabilityas one of your mission quadrant?
Dan Greenleaf (11:46):
I gotta start high here, Stacey, and talk about some macro
factors first so I can make a lot ofsense in why affordability matters
and some of this has comes from, youknow, some of the work Vivian Ho does.
So number one, we know over thelast 20 years, inflation is up 61%.
Wages are up, one 11, premiums are three14, and family responsibilities 326.
Stacey Richter (12:11):
Vivian Ho goes through all these stats and what they
all mean in a really stunning way.
Actually, in that episodelink in the show notes.
But you talked about how inflationis up a fraction, a fraction of the
rise in premiums and in out-of-pocketcosts for families for healthcare.
While meanwhile, wages areup a fraction of inflation.
So in real terms, the middle classis making less money than they used
(12:34):
to and materially less when you alsofactor in the cost of healthcare
getting taken out of their paychecks.
Mark Cuban actually talked about thisa lot, and he called the amount getting
taken out of paychecks, another tax, whichis actually a bigger tax than the tax.
Dan Greenleaf (12:48):
The actual dollars at families now are spending from 2000 to
2024 has gone from 6,000 to $24,000.
The average American makes $74,000 a year.
So when you think about like, wherethe financial discrimination is
occurring is unequivocally in themiddle class and lower classes, you
(13:10):
know, for lack a better description.
And it, it's disgraceful.
It's disgraceful to me that we'vedecided as a country that we're
gonna put the onus of these extremeincreases in care on the middle class.
So, I just wanna start there that thisis this is the lens I look through.
The second thing is I wanna point outis that there are three payers and
(13:34):
only three payers in the marketplace.
There's the taxpayers, there'sthe employers and the unions.
Everybody else is a middle person.
And so as I orient myself and orientmyself to discussions, those are the
three groups I focus on and I also wantyou all to know that I'm spending $85
million myself as a self insured employer.
(13:56):
So we're not only providing the care, butwe're also taking on that responsibility
of like making sure that we're notgetting disproportionately harmed by the
way the healthcare system's been set up.
So starting there, and that's againthe lens I look through, Stacey.
Stacey Richter (14:13):
We talk about this a lot on this pod.
The ones, the only ones footingthe healthcare bill are taxpayers,
employers, unions, and patientsthemselves increasingly.
So I'd put them on the end here.
How does all of this funnel intoyour affordability mission quadrant?
Dan Greenleaf (14:31):
So, if I think about affordability, and you and I
have talked about the MRI example,we do, we have 400 MRIs a day.
Think about this from, if thepatient was go to a hospital system
in Chicago, they're paying $4,500.
They come to Duly, it's $500.
That is 400, $400 million thatwe save the healthcare system
(14:55):
on just that service alone.
Colonoscopies.
We do 22,000 colonoscopies.
They are approximately $10,000less than it costs to have the
similar service done in a hospital.
That's another 220 million dollars.
And then you start looking at things justlike tummy tucks, $8,500 versus $70,000.
(15:19):
Knee replacements, $8,500 versus 65,000.
Hip replacements, $8,500 versus $50,000.
And what also gets missedin this discussion is the
patient responsibility piece.
So this co-insurance.
So something simple like an MRI,$4,500, 20% co-insurance is $900 to
(15:45):
that family versus a hundred dollars.
So that's an $800 difference.
And so Duly brings a level ofaffordability to Chicago marketplace.
You know, we're saving theemployers, the unions, and in
some respects, the taxpayers, wellin excess of a billion dollars.
I think it's probablycloser to $2 billion.
(16:07):
So affordability really matters inthis day and age, and I'm really tired
of, you know, frankly, the middleclass, this financial discrimination
that occurs in the middle class is aresult of this lack of transparency.
So nobody understands what anythingcosts, and they think they're going
to the best place because maybeit has a brand attached to it.
(16:29):
And at the end of the day, theircompensation is being affected by that.
Stacey Richter (16:34):
Yeah.
And that's something that Dave Chasefor one, has talked about for years.
Just the stagnation of middle classwages being directly attributable to
the increase in the dollars that aregoing to the healthcare industry.
While at the same time, for example, thefederal poverty limit is being calculated
(16:57):
based on things that tend to rise at therate of inflation, like food or gasoline.
Whereas you have this huge otherthat a huge proportion of wages right
now are going into the healthcareindustry that is rising at a
wildly high rate above inflation.
So I've just started to see callslately, which basically say we have
(17:19):
to change all this because to yourexact point, you know there, there's a
reason why 61% of Americans, I believe,have said that they are dealing or
foregoing care due to fear of cost.
We had Merrill Goozner onwho gave a great example.
He's like, what is this spot on my arm?
Is it melanoma?
I don't know.
But I do know that's gonna cost me$600 to go to the doctor to find out.
(17:40):
So I'm just gonna wait and see, I guess.
You know, I have chest pain.
Am I gonna go to the doctor?
I wanna think real hard about that'cause I don't wanna bankrupt my family.
Dan Greenleaf (17:47):
And you look at the culprits in this, Stacey, the
hospitals have increased at 256%over that same period of time.
So all this consolidation that's occurredhasn't driven quality, hasn't driven
access, hasn't driven affordability.
All it's done is raise prices andat at that same period of time.
If you look at physician comp andadjust for inflation, and I think
(18:11):
you know this, it's down 36%.
So the folks that are actuallyproviding the care are the ones
that are getting penalized.
Stacey Richter (18:19):
I think that we have made a very compelling
rationale for why focusing onaffordability really matters here.
And we are talking aboutmission and I don't wanna, I
don't wanna go off track here.
Um, we will talk about margin andobviously, foreshadowing to the max, but
I'm gonna ask you, how can you afford todo an MRI for $450 and still make money
(18:42):
when the hospital down the street ischarging 4,500, very unapologetically.
Right.
Or all the things that you just mentioned.
But what we're taking away from thismission is that it actually really is
very mission focused to try to figure outhow to charge a fair price for services
rendered, especially because of thepatient affordability bit here and the
(19:06):
fact that patients are paying 20% orhave these high deductibles or whatever.
So if we're concerned aboutpatient health, making care,
affordable really matters.
It's not some kind of like, you know,off to the side secondary consideration.
Which leads, I think very, itwas a lovely segue into access.
The second thing that you mentioned,how is that part of your mission?
Dan Greenleaf (19:26):
Yeah, I mean, on average our access is two days.
So if you have an appointment with usand you have a follow on appointment,
for example, it's two days and thehospitals in Chicago are between
eight and 60 days, and on averageyou get into see us 20 days sooner.
And I have an example of somebody on myteam, a young lady in her twenties that
(19:50):
got diagnosed with colon cancer and thenwas told she wouldn't be able to see,
have a follow on appointment for 60 days.
So this stuff is real.
And fortunately she knew somebodyand she could make a call, but
not everybody knows somebody.
Could you imagine getting adiagnosis for cancer and say,
Hey, we'll see you in 60 days.
(20:10):
Do you imagine what that would belike, you know, for the next 60 days?
And so this matters.
This matters a lot.
Stacey Richter (20:17):
This also goes back to the affordability component,
a quadrant of your mission.
Because what winds up happeningwhen patients don't have access?
I'll tell you what happensbecause this is proven.
Listen to the show about emergency rooms.
What winds up happening is that thosepatients then wind up in the emergency
room, which winds up costing everybody alot, therefore diminishing affordability.
(20:38):
So these are not unrelated aspects here.
Dan Greenleaf (20:41):
And we, it's so good.
We just did an Avalere study just onMedicare fee for service, and we were
25% less expensive in the hospitals.
But interestingly enough, 15%fewer hospital admins in 13%.
Fewer ER admins.
So you're absolutely right that accessand affordability drives lower cost.
Stacey Richter (21:07):
Yeah, there was a show called the, I think it's called
like Primary Care and Emergency Roomthrough Line Show, where basically
I cited about 90 stats, whichvalidate exactly what you're saying.
All right.
Your third one, again, not unrelated here.
These are all kind of a, yeah, youcan start to see how they all fit
together is consumer experience.
Dan Greenleaf (21:28):
So we, we partnered with Press Ganey and we do approximately,
you know, I don't know how manysurveys we actually do, but we get
50,000 responses on a quarterly basis.
And we use that to gaugeour net promoter score.
Net promoter scores are very familiarway to measure consumer experience.
(21:51):
Our net promoter score is 74.
Anything above a 70 is world class.
And so who's in that category with you?
It's all these kind ofamazing global brands.
So think Amazon, thinkStarbucks, think Netflix.
Hospitals on the other hand, their averagenet promoter score nationwide is 46.
(22:13):
And so again, from a consumer experiencestandpoint, we are far superior in
the other entities in the marketplacewhen it comes to consumer experience.
Stacey Richter (22:23):
There's a difference between hospitals and clinicians
who work at hospitals, and I thinkthat's really important to point out.
Like if you are talking about aspecific nurse or a specific doctor,
the level of trust in those individualsis generally speaking, rightfully
so, most of the time very high.
But if we're talking about theorganization of the hospital itself.
(22:46):
And again, not throwing everybodyin the same blanket category here,
because there are hospitals and thenthere are these consolidated health
systems that are very, very different.
But if you start looking at the patientexperience from beginning to end, like
after they got their bill, which was $700higher than they thought it was gonna be,
or after they couldn't figure out how toget an appointment or after they had a
(23:08):
question and no one answered it, that'swhat you're talking about here where
the overall net promoter score for theorganization itself can be shockingly low.
And the thing that a patient isgoing to be considering as they're
considering their care and whetherthey wanna do the follow up, this
definitely has clinical relevance also.
Dan Greenleaf (23:31):
I just wanna bring up, you know, we save these families of
four an average of seven to $14,000.
And one of the things that we're nowdoing is we're educating the consumer.
We're telling the consumer by comingto us and by getting care from us,
not only are you gonna have a superiorconsumer experience, but you're also
(23:53):
going to understand how much things cost.
And we're gonna continue to do that.
Stacey Richter (23:58):
Okay?
So this is another point ofintersection in these mission quadrants.
If you are less expensive, then howyou make that into a competitive
advantage, especially with patientsthese days, even if their employer is
unconcerned about it and frightfully,many C-suites are wildly unconcerned.
I'll link to a post Patrick Moore put inLinkedIn the other day that was shocking.
(24:20):
But if your prices are reasonable, thenyou can be transparent about said prices
and educate patients on how much saferyou are from a financial standpoint.
You told me before that you put posterson the walls talking about prices.
And I really just wanna point out thefundamental difference in the calculus
that's happening here for consumerexperience then one normally hears.
(24:44):
So if you are in a room of executivesand someone starts talking about
consumer experience, what oftengets brought up is like, is there
lemon water in the waiting room?
But if we're really thinkingabout what matters in the consumer
experience continuum, it's goingto be stuff like bankrupting
financial bombshell on the backend.
The more effort put into financialtransparency, the better the patient
(25:05):
experience because they have somecertainty about what is gonna
happen with their financial future,which is very anxiety provoking.
So we're saying that transparency is partof the consumer experience, and then just
the affordability, you said seven to 14kless also part of the consumer experience.
Alright, we started out with fourquadrants of what mission means.
We talked about affordability,we talked about access, we
(25:27):
talked about consumer experience.
Lastly, we've got quality here.
And I think one of the things alsothat's just becoming very clear is how
intertwined all of these things are.
But let's, let's talkspecific quality now.
Dan Greenleaf (25:40):
We've got many examples, but these are three examples
that I think are very relevant.
So we do a fair amountof prostate screening.
We biopsy the patient, you know, there's asurface antigen or whatever the tests are.
But in 77% of the time thatwe do a biopsy, it's positive.
The national average is 25%.
(26:03):
Think about that in terms of like theamount of waste and biopsies that are
being done at the expense of the patient.
And the fact that Duly does itright, 77% of the time the national
average is 25% is remarkable.
The second one I like to point out isthat hips and knees, not only do we look
(26:25):
at quality outcomes, which are terrific,but we also get feedback from the patient.
We're interested in likethe patient experience.
What's it been like, what's patientreported outcomes look like?
And in hips and knees we arewell above the national average.
In fact, you know, we've done sucha good job here that we're gonna
expand in the spine and pain.
(26:45):
So patient reported outcomes.
The last one is, is I'll justshare with you and there's
many more, is lung screening.
And what we do on the lung screeningside is we do a lot of outbound calls,
like it's kind of inconvenient andwe don't get paid for outbound calls.
Not that it matters, but we catch thepatient stage one or two and not three and
(27:05):
four, and we've been doing this for years.
We have detected hundredsof early stage lung cancers.
So it's not just about affordabilityand about access and about consumer
experience, but our quality.
And you know, we've got otherexamples of activation campaigns
that we do, and our activationcampaigns are with existing patients.
(27:30):
They focus on things like colonoscopies,mammograms, wellness visits, diabetic
screenings, but we've got some remarkablestories of where we've detected breast
cancer and I don't know how many casesand when the person wasn't aware of it.
And in one instance, I mean, weliterally, you know, from the time
that SMS message went out to time, theygot put on therapy, it was 25 days.
(27:55):
And I'm just tellingnobody does it like that.
So we're, we're just doing alot of stuff in this area and we
really, it's in our clinical DNA.
Stacey Richter (28:03):
And I really just want to underline this because we're
kind of talking about this like it'sa given and I really just wanna point
out how much it's not because youdo not run across very many groups
in general of clinical organizationswhere you can say, define your mission,
and they can come back and say, itis comprised of these four components
(28:26):
in the way that you are doing here.
Where very focused on affordability,access, consumer experience, and quality
like that is very much how we're definingmission, which is really a huge reason
why I was so excited to have you on theshow because it is actually so unusual.
Dan Greenleaf (28:42):
You know, I'll also point out like, you know, they did these
healthy community evaluations and in onecommunity page we see 40 to 50% of all
the patients there, and that community'sranked one of the highest from a healthy
perspective communities in the country.
So what we're doing, and again,not all zip codes are the same.
(29:03):
We know that, but at least in the oneswe're in, we're making a difference.
Stacey Richter (29:06):
This really ties to an episode with Dr. Ben Schwartz, where
he says something about understandingyour return on mission and also an
upcoming episode with Shane Ceroneand Sam Flanders from Kada Health.
And they say something fascinatingabout aligning incentives so that the
hospital's goals are consistent withdelivering value to the community rather
(29:28):
than just increasing volume or prices.
I mean, it's just so fundamentaland so not status quo.
So Dan Greenleaf, if someone is interestedin learning more about Duly, if they are
in the Chicago area, especially if they'rea plan sponsor, if I'm picking up what
(29:49):
you're putting down correctly, where wouldyou direct them for more information?
Dan Greenleaf (29:53):
Yeah, I think you can go to our website, duly.com.
You can go to my LinkedIn page.
We publish a lot of things about theorganization and what we're doing,
and if people wanna reach out tome, it's dan.greenleaf @duly.com.
I'd be happy to talk withpeople who are involved here.
I've done something verysimilar I've shared with you.
I've reached out to a few people who I'veheard on the podcast, so I would certainly
(30:18):
wanna extend that invitation as well.
Stacey Richter (30:22):
Okay, so today we, meaning Dan Greenleaf and I talked
about mission, we talked about the fourquadrants of mission, affordability,
access, consumer experience, and quality.
Come back next week because what we'regonna talk about next week is how mission
and margin can really be complimentary.
(30:43):
And spoiler alert, a big piece of thatis making sure physicians and other
clinicians have a very real seat atthe table and even an ownership stake.
What Dan Greenleaf also talks about,and this is something that Shane
Sarone and Dr. Sam Flanders talk about,is just how important it is to do
cost accounting to really understandwhat efficiency actually means.
(31:07):
Then lastly, I definitely grill Dana little bit about what it is to
have a capital partner and when itcomes to capital partners, what the
mission margin balance looks like.
So that said, see you next week.
Tom Nash (31:22):
Hi, this is Tom Nash, one of the RHV team members.
You might recognize my voicefrom the podcast intro.
If you love the show and you wannashow us your support, please follow
us on your favorite podcast app.
Sign up for the newsletter,or maybe consider making a
small donation in the tip jar.
Thanks so much for listening.
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