October 9, 2024 • 43 mins
Unlock the strategies that are shaping the future of independent physician practices, with our esteemed guests, Sherry Roussarie and Kelly Macken-Marble. Their insights promise to guide you through the maze of leadership challenges, collaboration necessities, and the incisive market strategies that are vital for anyone invested in healthcare's evolution. Drawing from Sherry’s prowess in marketing and payer relations and Kelly’s transition from hands-on nursing to administration, their conversation is a beacon for those navigating the industry, revealing the importance of visionary partnerships like the one at Integrative Care Partners network in fortifying independent practices.
Ready to see how technology is sparking a revolution in healthcare? We've got the conversation that maps out the terrain where AI and advanced technology intersect with the day-to-day operations of medical practice. Sherry and Kelly analyze the role of AI in patient care and administrative efficiency, and they dissect the emerging models that are redefining physician practice and hospital administration. This discussion is an invaluable resource for grasping the transformations that tech is driving in healthcare, and how these advancements are creating both challenges and opportunities for providers.
We round off our journey with a deep dive into market trends and the core metrics that healthcare CEOs must prioritize. The dialogue transitions from the effects of private equity to how healthcare market dynamics vary across different states, offering a nuanced look at the interplay between health systems and independent practices. We highlight the importance of financial health, employee satisfaction, and innovation as critical success indicators for leaders in the healthcare industry, offering a masterclass in navigating the competitive and ever-changing landscape of providing quality care. Join us for these enlightening revelations that could redefine your approach to healthcare leadership and strategy.
Sherry & Kelly co-authored "Two Rivers: The Power of Collaboration". You can buy a copy of your own from any of these fine retailers:
-or-
Directly from the publisher, Warren Publishing
Visit our website
Like us on Facebook
Tweet @ us on Twitter
Follow on Linkedin
Send an email contact@shpllc.com
Production © Strategic Healthcare Partners, LLC.
All rights reserved.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Aaron C Higgins (00:03):
Welcome to Beyond the Stethoscope, vital
Conversations with SHP.
As we take a summer break toprepare for Season 5, we're
revisiting some of our mostimpactful episodes.
In this episode from Season 4,we unlock the strategies shaping
the future of independentphysician practices with Sherry
Rochery and Kelly Macon-Marble.
Sherry's expertise in marketingand peer relations, combined
(00:27):
with Kelly's transition fromhands-on nursing to
administration, providesvaluable insights into
leadership challenges,collaboration and marketing
strategies essential fornavigating the evolving
healthcare landscape.
Sherry and Kelly also explorehow technology, particularly AI,
is revolutionizing healthcare.
They discuss AI's role inpatient care and efficiency in
(00:50):
administration, as well asemerging models that are
transforming physician practicesand hospital administration.
We delve into the market trendsand core metrics that healthcare
CEOs need to focus on,including the impact of private
equity and regional marketdynamics.
This episode offers acomprehensive look at financial
(01:10):
health, employee satisfactionand innovation as key success
factors for healthcare leaders.
Join us for these enlighteninginsights that could redefine
your approach to healthcareleadership.
Sheri and Kelly alsocoauthauthored a book Two Rivers
the Power of Collaboration.
We do talk about it a littlebit in this episode, but be sure
(01:31):
to look back in the archivesfor our full breakdown with the
two authors.
If you find this episodevaluable.
Please rate and share ourpodcast from your favorite
podcast app.
It really helps us reach morelisteners.
Thanks for tuning in and let'sstart this vital conversation
(01:56):
with Sherry and Kelly.
Jason Crosby (01:59):
Before we get into our interview, jason and I want
to say a few things about ourguests.
So, jason, yeah, so KellyMcInmarble and Sherry Rosary are
former clients of ours.
We were engaged in 2018-2019timeframe for about three to
four years as a partner to helpform a clinically integrated
network called Integrative CarePartners.
This involved several practicesin the South Bend market where
(02:24):
we helped facilitate startup andran the administrative side, if
you will contracting, analytics, et cetera in tandem with the
employees that were on part ofeach of the practices within ICP
or integrative care partners.
That engagement did cease in2021, I believe, but there are
(02:47):
former clients we have kept upwith.
We developed a goodrelationship and became admirers
from afar, especially afterthey wrote the book that we're
about to discuss.
Aaron C Higgins (02:57):
And I think it's important to be clear that
the partnership didn't break upBecause there was some kind of
falling out.
There was a significant marketchange in the area that kind of
made the whole thing redundantthat's correct.
Jason Crosby (03:11):
So, in essence, uh , one of the founding practices.
There were actually a couple ofmergers that took place during
that time and parent companiesoutside the state of Indiana in,
in fact, and so it was just anatural transition of
dismantling and disengagement,if you will, between us and ICP.
Still very good relationshipswith those involved.
(03:33):
Just a natural transition.
Aaron C Higgins (03:36):
Yeah, I think it's important to be honest and
upfront about the relationshipsthat we have with some of our
guests.
So thank you for explainingthat, jason, and with that,
let's go to this great interviewwith Kelly and Sherry.
Jason Crosby (04:00):
All right, let's start with a brief background
from you both, as you both eachhave a unique perspective of
starting your healthcaremanagement careers Kelly from
the clinical side, sherry fromthe marketing and payer side of
things.
Let's start there.
Maybe, kelly, if you'll kind ofget started, give us a little
background on how you arrived tothe position you're in today.
Sherry Roussarie (04:22):
Sure, my dad was a cardiologist.
So out of six kids I think itwas all assumed we would work in
healthcare and most of us didactually.
So I started out in nursingnursing background, went to
nursing school, actually workedin the ICU, bedside, nursing in
the ICU for a period of time andthen had this personal
(04:43):
experience with a daughter whowas sick and we've got to
experience healthcare all overthe country actually and it
really helped me see healthcarefrom a different perspective,
All the things that were brokenwith healthcare and made me
think maybe I had more to offeron the administrative side.
So chose to go down that pathand went back to school, got a
(05:07):
bachelor's degree in healthcareadministration and then a
master's degree inorganizational management, and
have really spent the majorityof my career in healthcare
administration.
Jason Crosby (05:18):
Fantastic, fantastic and Sherry about
yourself.
Kelly Macken-Marble (05:21):
I really started my career out in the
not-for-profit arena, startedwith Easterseals and March of
Dimes, working in those markets,and then moved into healthcare
marketing.
So first ER services, primarilyto businesses and that sort of
thing, and then moved intowomen's health services and then
(05:43):
a brain injury rehab and aftera time I decided to go back to
get my MHA and MBA and then fromthere moved right into managed
care.
My administrative residencyfrom my MHA MBA led me into
(06:04):
managed care where I got toreally study what was happening
in the hospital settings andpayment and reimbursement from
the health plans through themanaged care piece.
And then I moved into runningIPA networks in the Houston area
and then eventually to a PHO inIndiana and from there it was
(06:27):
really a natural migration intophysician group leadership.
So it was a very naturalbackground that gave me
knowledge of the business, ofthe business, learning about
physician reimbursement undercapitation models.
I learned healthcare plancontracting and I think the most
(06:48):
important experience I gainedwas the value and the importance
of independence andinterdependence among the
healthcare parties.
Mike Scribner (06:57):
I guess this is for both of y'all I apologize,
it's not on the list when I hearboth of y'all kind of go
through that.
What always amazed me when wewere working together in the icp
world was how quickly you guysdeveloped a shared vision and
went to kind of a seamless levelof collaboration and we just
(07:18):
kind of drew us in into that andit wasn't like I don't know,
jason coming too.
It didn't feel like that.
We went through this kind oflearning to work together phase
like y'all just immediately kindof vibe together and had a
shared vision.
What about your backgrounds orwhat about your kind of working
history kind of led to that, youthink Both of y'all.
Sherry Roussarie (07:41):
Both of you.
The alignment was I mean, weboth had a passion, came from
different directions, but forthe place of independent
(08:17):
physicians in healthcare todayand what we both saw happening.
That was threatening that.
And again, I think ourexperiences were different and
how we got to that place, but itcreated a passion for both of
us.
And I hadn't.
Honestly, when I met Sherry, Ihad been out of supporting
independent physicians for sevenyears maybe.
I mean I, you know, but Istarted my career there and so
(08:40):
it never left, you know.
And so all my years as acaution myself, using these
words hospital administrator Iguess I am one again, by the way
I always leaned towardssupporting independence because
I knew the value and I knew thevalue they could bring to the
hospital because they were lowercost and I didn't have to
(09:01):
employ them.
To me it was a greatpartnership.
So I really feel like, again,we kind of came to where we were
at in different ways, but wejust shared that mutual sort of
passion for preservingindependent physician practice.
Kelly Macken-Marble (09:16):
I think that's true and when we met it
was almost as though we hadknown and worked together for
years because we were so aligned.
There was such energy that cameout of that meeting and I think,
Mike, a lot of what ourpersonal background gave us,
with the personal experiencesand dealing with the challenges,
(09:41):
the losses and those sorts ofthings from our personal
experience.
It gives us the perspective offocusing on those things that
are the possibilities of whatcan be done versus those things
that are the obstacles that aregoing to prevent us from doing
what could be done.
(10:02):
So I think it's just really Idon't think that everyone has to
experience what Kelly and Ihave experienced to have that.
I think what we have to do ingeneral is have an openness to
say what can be and, as Kellyand I both at our at our core,
(10:25):
we start with yes and thenfigure out how to, how to make
that yes work there's a chapterin the book called delusional
optimism and it comes from thatright when you have challenges
that are just awful and feelinsurmountable at the time and
(10:47):
not everybody does.
Sherry Roussarie (10:48):
but I think we both left those experiences
with really anything's possible.
Mike Scribner (10:54):
So what would you say were the roadblocks you did
encounter in kind of learningto not work together but develop
that shared vision together asy'all went forth, but develop
that shared vision together asy'all went forth.
Kelly Macken-Marble (11:05):
You know, our roadblocks really were
external to Kelly and to me.
They were external to ourorganizations.
Actually, you know, youcertainly had those people who
were afraid, and change isalways hard, or the possibility
of change is always hard.
Our roadblocks came from thepeople that we were attempting
(11:29):
to partner with and those thatfelt like that we were creating
competition, even though we werethere saying, as Kelly and I
did in our first meeting, sayinglet's do this together, let's
create something that willbenefit the community, that will
raise the quality of care inour community, the access to
care in our community, and, atthe same time, really could
(11:53):
lower costs.
So let's do this together.
And we went to the hospitals,we went to the facilities and we
went to the networks of thosefacilities, the payer networks
of those facilities.
That would be probably thefirst roadblock that we hit
along the way, and therecertainly were others and plenty
(12:15):
of them, but those became someof our most creative roadblocks.
Jason Crosby (12:20):
I see Kelly smiling and yeah, as you guys
encountered those particularbarriers, the other
provider-type networks.
Looking back, what would yousay was sort of your approach,
going in that maybe now thatyou're looking back on how those
stories unfolded or didn'tunfold like you anticipated what
(12:41):
would have been a differentapproach, do you think if a
difference could have been madewith a different approach that
maybe at the time did notresonate with those particular
provider networks?
Sherry Roussarie (12:52):
Well, you know , we've had a lot of time to
reflect now and I think about ita lot because I'm in a
situation now, from the otherperspective, where I'm just
watching the same thing play outin a different market,
essentially, just watching thesame thing play out in a
different market, essentiallyand I think we were trying very
hard to be collaborative and tobe respectful and to try to
(13:16):
bring the existing networksalong and not be intimidating or
, you know, aggressive.
I think that was fine, because Ithink that's who Sherry and I
are, that's how we approach thework that we do.
If we had to do it over again,we could have been more
aggressive, and what I mean bythat is we weren't going to
(13:40):
change their positions.
Right, we had some big playerswith a lot of money in different
situations you know, differentsituations than what we were in
but we had a really strong handto play.
I think we probably could havegone into the market in a more
aggressive way.
(14:02):
I don't think the reactioncould have been any stronger
than what it was.
So, yeah, that's my thought.
Kelly Macken-Marble (14:10):
Yeah, I agree with that, Kelly, and I
think with how we approached thehospitals and how we approached
the networks.
We were very open.
We started very early on in theprocess to tell them here's
what we're planning to do.
We want you to be a part ofthis.
I don't know that I would dothat a whole lot differently,
(14:35):
because we did make everyattempt to try to include them
and bring them in.
There are some other placeswithin our partnerships that we
did do.
Then I would probably choosedifferent partners or, you know,
look for differentcollaborators than what we had.
(14:57):
But from the kickoff of what wedid, I'm not sure it would have
changed a whole lot.
I think we did that well, kelly, I did too.
Yeah.
Mike Scribner (15:07):
So can we go?
Kelly made the comment a minuteago about independent practices
, independent providers in themarket and sort of a passion for
that.
How has that environmentchanged over time?
What are the kind of keythreats that have come at that
and what do you think is the youknow?
What are the solutions?
What's the future look like forthat?
Sherry Roussarie (15:29):
Yeah, it's a great question.
You know, as I said, I startedmy career in supporting
independent physician groups and, you know, grew up in my dad's
practice, which was anindependent group, and then
spent 27 years in corporatehealth care.
And what I see happening, and Iremember the decision to leave
(15:51):
a private practice environmentand take a role in a health
system for the first time and itwas very intentional because
even 30 years ago the physicianpractices were being purchased
there were 30 years ago.
There were very few leftalready at that point in the
area that I lived in inSouthwest Michigan, so it was
(16:13):
very intentional to try tounderstand this other healthcare
sector that I really hadn'tbeen very involved in.
And what I've seen justcontinue to grow is the
financial drivers around payercontracting and reimbursement
(16:34):
just getting harder and harder.
It was there 30 years ago andit's harder.
It's even harder today.
The financial investments thatit takes for independent
physicians to stay in practicewith purchasing electronic
medical records and you know,having that whole infrastructure
(16:56):
to support their practice is isdifficult for many to be able
to sustain and the margins areso narrow for them that it you
know, the return on investmentjust is not there for them.
And so what I see happening isthat just continuing to get
harder and harder and harder.
(17:16):
A few years ago in Indiana, youknow, and it's still this way
today across the country, thesize of the organization and the
number of physicians you haveis how you get leverage in payer
contracting.
There is no, they say, value,value-based contracting.
But your cost of care, yourquality of care, delivery, is
(17:41):
not included in the payercontracting process.
It doesn't matter.
And so you know, insurancecompanies today are still 100%
tailoring contracting to meetthe big systems, even if they're
, you know, paying them 300% or400% of Medicare and they're
(18:04):
willing to do that really at andwill pay an independent group,
like the ones that Sherry and Isupported there, below Medicare
rates.
And when you bring that totheir attention, it doesn't
matter, it doesn't matter.
So you know what I, what I heara lot, is.
(18:24):
You know, value based care isgrown.
It's, I think, it's somewhatstagnating right now.
It's still there.
There's a lot of value-basedcare opportunities
contracting-wise, but it is notyet the driver and until that
happens, you know, I think it'sthe system itself, the
reimbursement system and thepayer contracting system is.
(18:46):
It disincentivizes independentphysicians and that is just
getting harder and harder.
Mike Scribner (18:52):
So would your answer to that question be the
same for independent primarycare versus independent
specialty?
It seems to be a bit differentin our world Like it's a good
time to be primary care where weare, you know, farther in the
southeast it's more of anemerging market than it is maybe
a fully developed one.
Be primary care when we are.
Farther in the Southeast it'smore of an emerging market than
it is maybe a fully developedone like you are.
(19:13):
So it feels like it's driftinginto its heyday, whereas there's
a lot of cobwebs on thesurgical specialty with an ASC
hunk of the world very stuck infee-for-service kind of spiral.
Fast forward me and y'all'smarket to what that looks like.
Is it still, you know?
Is it a good day to be aprimary care in a more mature
(19:37):
market like that?
Sherry Roussarie (19:39):
I mean the incentives for primary care
physicians today, this wholeemerging and rapidly growing
Medicare Advantage.
You know, insurance populationis where they have opportunities
.
It's where primary care hasopportunities to generate
additional income.
So it is making a bigdifference and that's why you
(20:00):
see all kinds of startupsgetting into that business and
partnering with independentprimary care groups to help them
build the infrastructure to besuccessful in that environment.
You are disincentivized in thatmodel having specialists.
They only hurt you, right?
They add cost and that kind ofthing.
(20:20):
So, yes, I think so it is, butI'm not sure it's enough, quite
frankly, because without,without, you know, the startup
companies that you know willprovide the population health
infrastructure and you know, cando the aggressive, you know,
pair contracting side of it.
(20:40):
They take the majority of theincome.
The clinicians still, you know,benefit from that, but it's,
yeah, it's, it's tough.
And then on the specialty side,benefit from that, but it's,
yeah, it's tough.
And then on the specialty sideand I don't think it's changed a
lot in the last couple of yearsyou know the hospitals are
replacing the specialists withtheir own employed, and so
that's, you know, that's, thatis the challenge on that side of
(21:02):
it.
But, yes, there is someincentive for primary care
Currently.
I'm just not sure it's enough.
Julia DiGiacomo (21:10):
We'll be right back.
Did you know?
Shp provides cradle-to-gravemanaged care contracting
services.
Shp offers comprehensivemanaged care contracting
services, from contract languagereview to reimbursement rate
analysis.
We address charge level,clinical coding, billing and
appeals to optimize overallreimbursement.
Don't let aging contractshinder new services or locations
(21:33):
.
Be proactive with SHP managedcare contracting.
Visit shplccom for details.
Jason Crosby (21:43):
I kind of want to pivot.
I know we've talked about payermechanisms, payer reimbursement
all day and the impact it's gotKind of shifting to more recent
headlines, I guess you couldsay and disruptors that you see
not just on the retail side, butAI.
Everybody's reading everythingabout the impact of AI.
We've interviewed some in thecare management space as well
(22:05):
and it's pretty interesting tohear where they see things going
.
What do you guys see inparticular in the independent
practice side, where maybesomething like AI or any form of
automation and technology couldhave an impact on the practice
for an independent practice?
Kelly Macken-Marble (22:23):
AI covers.
It's such a broad category.
It's such a broad topic and thefirst thing that I think of
when I think of AI in a medicalpractice is a patient showing up
with their AI generated.
Here's what I learned about mydiagnosis.
(22:44):
So, doctor, here's how you'resupposed to treat me.
I think there is certainlygoing to be more of that kind of
thing because as it gets easierto access that information and
come in with it.
But certainly a caution to allof us healthcare consumers be
careful.
We know that those mistakesexist within AI and that's not
(23:07):
something that we're going towant to go in and tell the
physician how to practicemedicine.
I think the practices have someopportunity with AI and how they
use it and can capture perhapscertainly spitting out
(23:29):
information about a patient'sdiagnosis and treatment and
those sorts of things and whatthey can do with it.
It could be very beneficial forthe treatment of patients and
the aftercare and those sorts ofthings with the patients In
terms of how to manage withinthe practice itself.
(23:49):
Are there ways that we coulduse AI to determine how the
payers are paying us?
Are we getting paid what we'resupposed to get paid?
What are the clawbacks doingthat are happening from the
payers and can AI help us to bemore efficient and better at
(24:11):
determining that sort of thing,which could generate millions of
dollars for a practice of whatthe health plans actually
underpay them.
So I think that's a reallyopportunity in that arena to
gather data and information andhelp to benefit the practices
(24:31):
through AI.
Sherry Roussarie (24:34):
Yeah, I agree, sherry and I had a chance to
listen to a radiologist speak tosome of the AI functionality in
that particular specialty andit's phenomenal.
And there are some specialtiesthat I don't know.
I mean they're getting reallyreally hard to recruit.
(25:09):
You know any of the internalmedicine subspecialties
rheumatology, endocrinology,really any of them.
And so if there's any portionsof that that, can you know?
Ai can make a difference justreading images.
You know that's helpful, thatfor radiology specifically,
that's becoming pretty advanced.
It'll never take the place of aperson.
They were careful to you know,call that out.
But I think there's lots ofopportunities on the
(25:29):
non-clinical side.
So much opportunity for expensereduction.
You know what I'm hearing rightnow, like in the space of
health information managementautomating.
There's a lot of it that'salready been automated, but with
AI even more.
And so there are a lot ofhealthcare companies looking at
(25:50):
how they may be able tocompletely eliminate or
outsource HIM.
That's one area.
Revenue cycle there's a lot ofautomation and payment posting
and things like that already,but Epic, for example, is
working on building in more AIinto its software.
(26:12):
So there's going to be a lot ofefficiencies gained and may
help reduce overhead in a lot ofthe administrative areas.
Mike Scribner (26:20):
Can I go back, kelly?
You know as a lot of these sortof the wave of change as it
relates to physicians in general, independent physicians and the
alternatives that they have inmarkets have come at you now
sitting back in the seat ofhospital administration.
How does that make you thinkdifferently now?
(26:41):
Because you go back severalyears ago there was either
employment or there wasindependence.
Now there is value-based,enabler-tied independence.
There's corporate medicinequote-unquote independence
there's so many other flavors ofthat.
Now.
Medicine in quote unquoteindependence, there's so many
other flavors of that.
Now.
How does that make you have tothink differently now as you
(27:03):
look at your not employed but inthe morass around you market?
Sherry Roussarie (27:07):
Yeah, I mean I think the addition of private
equity into supportingindependent physicians does
bring a different dynamic, butnot necessarily a negative one,
and I think that's unfortunately.
(27:28):
I think there's a belief thatwith that evolution the focus on
the cost of care will go up forthose clinicians.
And I don't.
And I haven't seen that as Ihaven't read evidence of that
and I do look for that because Ihear it a lot.
Cms actually did some work onthat and there is no evidence
(27:50):
that that's really the case.
But now that I've been removedfrom the market that Sherry and
I were in and I'm in where I'mat, I feel like it's not any
different.
Right, it's the same.
It is the same as it was thereand really is in lots of places,
most places across the countryis it really is still health
(28:12):
systems versus independent,whether the independents are
backed by private equity.
The Minnesota market has a lotof very large independent
specialist groups that areprivate equity backed and they
pose quite a challenge for thehealth systems they do and in
(28:35):
the market I'm in right nowthere's actually a fair number
of independents left, one inparticular in right in my
immediate market.
That is a challenge for thehealth systems and you know I
feel really compelled to supportthem.
So yeah, I think back 30 yearsand I think about where things
(28:56):
are at today and sadly, not alot has changed.
I mean, you still really havethe choice of independent and if
you're independent, you've gota few other levers to pull, like
private equity and MedicareAdvantage.
You know contractingopportunities, which is a great
way to bring in some.
Kelly Macken-Marble (29:12):
You know additional income, but I'm not
sure Sadly, you know, a lot'schanged that way and Kelly's
(29:34):
view of independence, of beingable to lower the cost of health
care overall for the healthsystem by using what already
exists in the market with thesehigh-quality providers and you
don't, as the health plan, havethe cost of hiring them
yourselves, but then partner andcollaborate with them.
(29:56):
In our market in Indiana that'snot the case.
The hospitals view it that as ifyou are not working for us,
then you're working against us,and if you do not become
employed by us, we will employphysicians, no matter how much
(30:21):
this duplicates what alreadyexists in the market, because we
want to control that entiresystem and throughput of the
services, whereas thesephysicians had historically, or
since the beginning ofhealthcare time in South Bend,
(30:42):
had these two hospital systemsthat were the same physician
groups that serviced both, andas the competition at the
hospital levels grew, thehospitals felt like they had to
own everything and so it's adifferent.
I think it's still market bymarket as to what that looks
(31:05):
like, and the collaboration thatKelly is talking about is
absolutely right on target.
There's a place at the tablefor all of us place at the table
for all of us, but the healthsystem needs that vision and
(31:25):
those eyes to see how much theycan save by using some of that
existing.
And then they fill in the gapsin the areas where some of those
harder to recruit services sayyou know, urology might be a
difficult one to recruit, for itis across the nation.
Perhaps they would look therethat kind of thing where the
(31:46):
groups themselves, theindependent groups themselves,
are struggling more.
So we'd like to see that moreof what Kelly's talking about go
in through the rest of the US.
I think that's missing somewhat, certainly in our north central
Indiana area.
Mike Scribner (32:05):
Sherry blunt, assessment of the previous
market, the freedom ofretirement right.
You get to just say it the wayyou feel it.
Aaron C Higgins (32:14):
Beautiful thing isn't it?
Mike Scribner (32:28):
But let me flip that discussion around through
the eyes of the employer.
How have you seen that evolveover time?
Sherry, available, but go backfor both of y'all.
Go back 15, 20 years ago.
How have their requests, needs,models changed and how you
wanted to interact with themfrom a provider perspective?
Kelly Macken-Marble (32:55):
I think the employer's perspective has not
changed all that much andthey're looking for low cost,
high quality care.
They want to make sure, theywant to ensure that their
employees are well cared for,and what we are seeing and
experiencing now in many marketsis the insurer, the payer, is
(33:20):
now saying yes, of course, thispractice is in network and your
employees have access to thisbroad network of providers.
However, when the employee goesto access those services, a
physician within a larger groupmay not be included in that they
may not be covered in thatnetwork, and then, or a location
(33:47):
of that same practice may notbe covered in that payer's
network.
And so the employers are beingsold these broad networks that
can service their employeesthroughout a region and yet when
it becomes operational withinthose patients seeking care,
(34:11):
it's not available.
It's not available and it'sbecoming more and more difficult
.
It's starting to look to melike much like the HMO market
looked like in the 1990s andwhere you really had to be very
involved with your healthcare tounderstand what it was that you
(34:33):
were getting.
You can't just pick up yourprovider book and say I'm going
to go over here to see whetherit's this primary care or this
cardiologist, because thatparticular one may not be, even
though their entire practice isin.
Mike Scribner (34:45):
Kelly thoughts.
Sherry Roussarie (34:47):
Yeah, no, I was just laughing inside
thinking about how much back tothe HMO sort of feel as we were
in the 90s.
I mean it is very much thatmarket today.
I feel like you know it happensregularly that a group is in
but one or two doctors are out,and so it's complicated for
(35:10):
patients to manage.
But yeah, no, nothing other toadd.
Jason Crosby (35:16):
All right, like Mike mentioned, we tend to ping
pong our questioning back andforth, so I'm once again going
to pivot left, this time Kind ofbacking up.
You both have held numerous CEOroles, very successful,
different markets, differentsettings.
How, in the past, have youmeasured yourself as a CEO and
or the organization?
(35:37):
While as CEO, how did youmeasure yourself in the
organization, on you know as youwere moving along to your
success?
Were there certain metrics,certain you know, as you were
moving along, how did youmeasure yourself?
Kelly Macken-Marble (35:53):
Yeah, go ahead, sherry.
Well, you know, I think theythey're the standards.
You know you have yourfinancial viability and all the
factors that go along with that.
You have your physicianretention, your employee
retention.
All of those are those piecesthat we all measure, whether
(36:16):
it's in healthcare or inmanufacturing, in retail.
Those are the basis, those arethe standards.
I think where we really get intoit and where the fun is is when
we break a few eggs.
(36:37):
I think the most successfulorganizations are those that
really step into innovation andthey really embrace the idea of
change or to try new things, orto perform the old things in a
new way, and to take those risks, to step out and say let's try
(37:00):
this innovation.
Some of it's going to work,some of it is absolutely not
going to work, but these are thethings that really help to move
an organization forward.
And I've had the fortune, I'vehad the opportunity to do some
of those things in my careerhere in the South Bend area and
(37:24):
they were exciting and they werefun.
Some worked, some didn't, butat the end of the day, more
worked than those that did notand you see it in the result of
those typical metrics that youlook, you have the financial
viability, you have the employeesatisfaction and the physician
(37:46):
satisfaction and the retentionof those things that come along
with doing the things that areexciting.
But again you have to break afew eggs.
Sherry Roussarie (37:55):
I love the way you described that, sherry,
breaking eggs.
That's good, I agree.
I mean there are some standardmeasures right that we all look
at and I'm accountable to aboard for, you know, to be
successful, the typical sort offinancial measures and patient
experience measures and thingslike that I'm also a big
believer in.
For me, the most importantmeasure for me is around how my
(38:18):
employees feel.
So if they, you know, if youhave a team that feels valued
and engaged, everything elsejust gets better.
Right, your financials arebetter, and there's lots of
studies that have been done tokind of show that.
So I spend a lot of time onthat and on culture, and if you
know I'm successful there.
To me that's a huge win.
(38:40):
But so much of the work today isto remain viable.
You know we live in a worldwhere big health systems are
losing money and struggling tostay financially viable, and so
you know, a large part of thework is what Sherry did is said
(39:01):
so well is about how do we beinnovative, how do we do
something different to help keepthe organization viable and,
you know, be a value to thecommunity and to your patients.
So it's, you know, you've gotto be willing to think a little
(39:22):
bit different and you know I'mnot one to get caught up in
market share and sort offighting over that kind of thing
.
So I keep my team reallyfocused around what is our value
proposition.
You know what can we bring tothe community that not only will
take care of their sort of, youknow, basic primary care needs
and emergency needs and thingslike that, but you know what can
(39:44):
we also do in terms of serviceand support that will help us
ensure we're going to be here in10 years or 15 years.
So so much of the work isaround that.
So I do feel a fair amount ofyou know my role today and my
energy and time is the strategiclens of you know what is the
marketplace need?
What are we providing today?
(40:04):
What do we need to do differentto ensure that financial
viability and, you know, mostimportantly, be a value right to
the community?
Jason Crosby (40:16):
So I think that's a fair amount of the work
Fantastic.
That kind of dovetails nicelyinto our conversation I know
that we'll have tomorrow.
We kind of dive deep intoy'all's perspective in terms of
leadership.
It was a great conversation.
I appreciate you guys giving ussome perspective from the CEO
seat.
I know we're going to haveanother deep dive conversation
into the book Two Rivers thatyou guys released just last year
(40:39):
, right March or April of 23,.
Is that right Fantastic?
And we'll have a couple of newSHPers well, not new to SHP, but
new interviewers on for thatpodcast and we'll record that
tomorrow.
But appreciate you guys doingour podcast today.
Thanks again.
Sherry Roussarie (40:56):
Thank you.
Thank you so much, you guysdoing our podcast today.
Thanks again.
Aaron C Higgins (40:58):
Thank you.
Thank you so much.
This has been an episode ofBeyond the Stethoscope Vital
Conversations with SHP.
If you enjoyed this podcast,please be sure to rate and share
it with your friends.
Jason Crosby (41:11):
It sure helps.
The show.
Production and editing by NalaWeed Social media by Jeremy
Miller.
Aaron C Higgins (41:16):
And our co-hosts are me, aaron C Higgins
and Jason Crosby.
Our show producers are MikeScribner and John Crew.
Jason Crosby (41:24):
Thank you for listening and we'll see you next
time.
So our most important questionI need you to really focus, get
ready.
When Mike and I first met youguys, we had a lot of fun of the
you know two southern guyscoming up north.
We were scared how much snowand all that.
So I gotta ask you're thirsty?
(41:45):
You're going into a restaurant.
All they have are soft drinks.
Are you ordering soda or pop?
Kelly Macken-Marble (41:52):
I'm ordering coke.
Jason Crosby (41:55):
Southerner right there Okay.
Sherry Roussarie (41:58):
Pop Michigan.
Yes, that's all we called it inDetroit.
It was Pop, yeah, yeah for sure.
Jason Crosby (42:05):
Yeah, erin is our resident Northerner, since
Trenna is not with us.
Who are Minnesota Minnesota?
Mike Scribner (42:13):
Yeah.
Jason Crosby (42:14):
Minnesota.
Welcome to Beyond the Stethoscope, vital
Conversations with SHP.
As we take a summer break toprepare for Season 5, we're
revisiting some of our mostimpactful episodes.
In this episode from Season 4,we unlock the strategies shaping
the future of independentphysician practices with Sherry
Rochery and Kelly Macon-Marble.
Sherry's expertise in marketingand peer relations, combined
(00:27):
with Kelly's transition fromhands-on nursing to
administration, providesvaluable insights into
leadership challenges,collaboration and marketing
strategies essential fornavigating the evolving
healthcare landscape.
Sherry and Kelly also explorehow technology, particularly AI,
is revolutionizing healthcare.
They discuss AI's role inpatient care and efficiency in
(00:50):
administration, as well asemerging models that are
transforming physician practicesand hospital administration.
We delve into the market trendsand core metrics that healthcare
CEOs need to focus on,including the impact of private
equity and regional marketdynamics.
This episode offers acomprehensive look at financial
(01:10):
health, employee satisfactionand innovation as key success
factors for healthcare leaders.
Join us for these enlighteninginsights that could redefine
your approach to healthcareleadership.
Sheri and Kelly alsocoauthauthored a book Two Rivers
the Power of Collaboration.
We do talk about it a littlebit in this episode, but be sure
(01:31):
to look back in the archivesfor our full breakdown with the
two authors.
If you find this episodevaluable.
Please rate and share ourpodcast from your favorite
podcast app.
It really helps us reach morelisteners.
Thanks for tuning in and let'sstart this vital conversation
(01:56):
with Sherry and Kelly.
Jason Crosby (01:59):
Before we get into our interview, jason and I want
to say a few things about ourguests.
So, jason, yeah, so KellyMcInmarble and Sherry Rosary are
former clients of ours.
We were engaged in 2018-2019timeframe for about three to
four years as a partner to helpform a clinically integrated
network called Integrative CarePartners.
This involved several practicesin the South Bend market where
(02:24):
we helped facilitate startup andran the administrative side, if
you will contracting, analytics, et cetera in tandem with the
employees that were on part ofeach of the practices within ICP
or integrative care partners.
That engagement did cease in2021, I believe, but there are
(02:47):
former clients we have kept upwith.
We developed a goodrelationship and became admirers
from afar, especially afterthey wrote the book that we're
about to discuss.
Aaron C Higgins (02:57):
And I think it's important to be clear that
the partnership didn't break upBecause there was some kind of
falling out.
There was a significant marketchange in the area that kind of
made the whole thing redundantthat's correct.
Jason Crosby (03:11):
So, in essence, uh , one of the founding practices.
There were actually a couple ofmergers that took place during
that time and parent companiesoutside the state of Indiana in,
in fact, and so it was just anatural transition of
dismantling and disengagement,if you will, between us and ICP.
Still very good relationshipswith those involved.
(03:33):
Just a natural transition.
Aaron C Higgins (03:36):
Yeah, I think it's important to be honest and
upfront about the relationshipsthat we have with some of our
guests.
So thank you for explainingthat, jason, and with that,
let's go to this great interviewwith Kelly and Sherry.
Jason Crosby (04:00):
All right, let's start with a brief background
from you both, as you both eachhave a unique perspective of
starting your healthcaremanagement careers Kelly from
the clinical side, sherry fromthe marketing and payer side of
things.
Let's start there.
Maybe, kelly, if you'll kind ofget started, give us a little
background on how you arrived tothe position you're in today.
Sherry Roussarie (04:22):
Sure, my dad was a cardiologist.
So out of six kids I think itwas all assumed we would work in
healthcare and most of us didactually.
So I started out in nursingnursing background, went to
nursing school, actually workedin the ICU, bedside, nursing in
the ICU for a period of time andthen had this personal
(04:43):
experience with a daughter whowas sick and we've got to
experience healthcare all overthe country actually and it
really helped me see healthcarefrom a different perspective,
All the things that were brokenwith healthcare and made me
think maybe I had more to offeron the administrative side.
So chose to go down that pathand went back to school, got a
(05:07):
bachelor's degree in healthcareadministration and then a
master's degree inorganizational management, and
have really spent the majorityof my career in healthcare
administration.
Jason Crosby (05:18):
Fantastic, fantastic and Sherry about
yourself.
Kelly Macken-Marble (05:21):
I really started my career out in the
not-for-profit arena, startedwith Easterseals and March of
Dimes, working in those markets,and then moved into healthcare
marketing.
So first ER services, primarilyto businesses and that sort of
thing, and then moved intowomen's health services and then
(05:43):
a brain injury rehab and aftera time I decided to go back to
get my MHA and MBA and then fromthere moved right into managed
care.
My administrative residencyfrom my MHA MBA led me into
(06:04):
managed care where I got toreally study what was happening
in the hospital settings andpayment and reimbursement from
the health plans through themanaged care piece.
And then I moved into runningIPA networks in the Houston area
and then eventually to a PHO inIndiana and from there it was
(06:27):
really a natural migration intophysician group leadership.
So it was a very naturalbackground that gave me
knowledge of the business, ofthe business, learning about
physician reimbursement undercapitation models.
I learned healthcare plancontracting and I think the most
(06:48):
important experience I gainedwas the value and the importance
of independence andinterdependence among the
healthcare parties.
Mike Scribner (06:57):
I guess this is for both of y'all I apologize,
it's not on the list when I hearboth of y'all kind of go
through that.
What always amazed me when wewere working together in the icp
world was how quickly you guysdeveloped a shared vision and
went to kind of a seamless levelof collaboration and we just
(07:18):
kind of drew us in into that andit wasn't like I don't know,
jason coming too.
It didn't feel like that.
We went through this kind oflearning to work together phase
like y'all just immediately kindof vibe together and had a
shared vision.
What about your backgrounds orwhat about your kind of working
history kind of led to that, youthink Both of y'all.
Sherry Roussarie (07:41):
Both of you.
The alignment was I mean, weboth had a passion, came from
different directions, but forthe place of independent
(08:17):
physicians in healthcare todayand what we both saw happening.
That was threatening that.
And again, I think ourexperiences were different and
how we got to that place, but itcreated a passion for both of
us.
And I hadn't.
Honestly, when I met Sherry, Ihad been out of supporting
independent physicians for sevenyears maybe.
I mean I, you know, but Istarted my career there and so
(08:40):
it never left, you know.
And so all my years as acaution myself, using these
words hospital administrator Iguess I am one again, by the way
I always leaned towardssupporting independence because
I knew the value and I knew thevalue they could bring to the
hospital because they were lowercost and I didn't have to
(09:01):
employ them.
To me it was a greatpartnership.
So I really feel like, again,we kind of came to where we were
at in different ways, but wejust shared that mutual sort of
passion for preservingindependent physician practice.
Kelly Macken-Marble (09:16):
I think that's true and when we met it
was almost as though we hadknown and worked together for
years because we were so aligned.
There was such energy that cameout of that meeting and I think,
Mike, a lot of what ourpersonal background gave us,
with the personal experiencesand dealing with the challenges,
(09:41):
the losses and those sorts ofthings from our personal
experience.
It gives us the perspective offocusing on those things that
are the possibilities of whatcan be done versus those things
that are the obstacles that aregoing to prevent us from doing
what could be done.
(10:02):
So I think it's just really Idon't think that everyone has to
experience what Kelly and Ihave experienced to have that.
I think what we have to do ingeneral is have an openness to
say what can be and, as Kellyand I both at our at our core,
(10:25):
we start with yes and thenfigure out how to, how to make
that yes work there's a chapterin the book called delusional
optimism and it comes from thatright when you have challenges
that are just awful and feelinsurmountable at the time and
(10:47):
not everybody does.
Sherry Roussarie (10:48):
but I think we both left those experiences
with really anything's possible.
Mike Scribner (10:54):
So what would you say were the roadblocks you did
encounter in kind of learningto not work together but develop
that shared vision together asy'all went forth, but develop
that shared vision together asy'all went forth.
Kelly Macken-Marble (11:05):
You know, our roadblocks really were
external to Kelly and to me.
They were external to ourorganizations.
Actually, you know, youcertainly had those people who
were afraid, and change isalways hard, or the possibility
of change is always hard.
Our roadblocks came from thepeople that we were attempting
(11:29):
to partner with and those thatfelt like that we were creating
competition, even though we werethere saying, as Kelly and I
did in our first meeting, sayinglet's do this together, let's
create something that willbenefit the community, that will
raise the quality of care inour community, the access to
care in our community, and, atthe same time, really could
(11:53):
lower costs.
So let's do this together.
And we went to the hospitals,we went to the facilities and we
went to the networks of thosefacilities, the payer networks
of those facilities.
That would be probably thefirst roadblock that we hit
along the way, and therecertainly were others and plenty
(12:15):
of them, but those became someof our most creative roadblocks.
Jason Crosby (12:20):
I see Kelly smiling and yeah, as you guys
encountered those particularbarriers, the other
provider-type networks.
Looking back, what would yousay was sort of your approach,
going in that maybe now thatyou're looking back on how those
stories unfolded or didn'tunfold like you anticipated what
(12:41):
would have been a differentapproach, do you think if a
difference could have been madewith a different approach that
maybe at the time did notresonate with those particular
provider networks?
Sherry Roussarie (12:52):
Well, you know , we've had a lot of time to
reflect now and I think about ita lot because I'm in a
situation now, from the otherperspective, where I'm just
watching the same thing play outin a different market,
essentially, just watching thesame thing play out in a
different market, essentiallyand I think we were trying very
hard to be collaborative and tobe respectful and to try to
(13:16):
bring the existing networksalong and not be intimidating or
, you know, aggressive.
I think that was fine, because Ithink that's who Sherry and I
are, that's how we approach thework that we do.
If we had to do it over again,we could have been more
aggressive, and what I mean bythat is we weren't going to
(13:40):
change their positions.
Right, we had some big playerswith a lot of money in different
situations you know, differentsituations than what we were in
but we had a really strong handto play.
I think we probably could havegone into the market in a more
aggressive way.
(14:02):
I don't think the reactioncould have been any stronger
than what it was.
So, yeah, that's my thought.
Kelly Macken-Marble (14:10):
Yeah, I agree with that, Kelly, and I
think with how we approached thehospitals and how we approached
the networks.
We were very open.
We started very early on in theprocess to tell them here's
what we're planning to do.
We want you to be a part ofthis.
I don't know that I would dothat a whole lot differently,
(14:35):
because we did make everyattempt to try to include them
and bring them in.
There are some other placeswithin our partnerships that we
did do.
Then I would probably choosedifferent partners or, you know,
look for differentcollaborators than what we had.
(14:57):
But from the kickoff of what wedid, I'm not sure it would have
changed a whole lot.
I think we did that well, kelly, I did too.
Yeah.
Mike Scribner (15:07):
So can we go?
Kelly made the comment a minuteago about independent practices
, independent providers in themarket and sort of a passion for
that.
How has that environmentchanged over time?
What are the kind of keythreats that have come at that
and what do you think is the youknow?
What are the solutions?
What's the future look like forthat?
Sherry Roussarie (15:29):
Yeah, it's a great question.
You know, as I said, I startedmy career in supporting
independent physician groups and, you know, grew up in my dad's
practice, which was anindependent group, and then
spent 27 years in corporatehealth care.
And what I see happening, and Iremember the decision to leave
(15:51):
a private practice environmentand take a role in a health
system for the first time and itwas very intentional because
even 30 years ago the physicianpractices were being purchased
there were 30 years ago.
There were very few leftalready at that point in the
area that I lived in inSouthwest Michigan, so it was
(16:13):
very intentional to try tounderstand this other healthcare
sector that I really hadn'tbeen very involved in.
And what I've seen justcontinue to grow is the
financial drivers around payercontracting and reimbursement
(16:34):
just getting harder and harder.
It was there 30 years ago andit's harder.
It's even harder today.
The financial investments thatit takes for independent
physicians to stay in practicewith purchasing electronic
medical records and you know,having that whole infrastructure
(16:56):
to support their practice is isdifficult for many to be able
to sustain and the margins areso narrow for them that it you
know, the return on investmentjust is not there for them.
And so what I see happening isthat just continuing to get
harder and harder and harder.
(17:16):
A few years ago in Indiana, youknow, and it's still this way
today across the country, thesize of the organization and the
number of physicians you haveis how you get leverage in payer
contracting.
There is no, they say, value,value-based contracting.
But your cost of care, yourquality of care, delivery, is
(17:41):
not included in the payercontracting process.
It doesn't matter.
And so you know, insurancecompanies today are still 100%
tailoring contracting to meetthe big systems, even if they're
, you know, paying them 300% or400% of Medicare and they're
(18:04):
willing to do that really at andwill pay an independent group,
like the ones that Sherry and Isupported there, below Medicare
rates.
And when you bring that totheir attention, it doesn't
matter, it doesn't matter.
So you know what I, what I heara lot, is.
(18:24):
You know, value based care isgrown.
It's, I think, it's somewhatstagnating right now.
It's still there.
There's a lot of value-basedcare opportunities
contracting-wise, but it is notyet the driver and until that
happens, you know, I think it'sthe system itself, the
reimbursement system and thepayer contracting system is.
(18:46):
It disincentivizes independentphysicians and that is just
getting harder and harder.
Mike Scribner (18:52):
So would your answer to that question be the
same for independent primarycare versus independent
specialty?
It seems to be a bit differentin our world Like it's a good
time to be primary care where weare, you know, farther in the
southeast it's more of anemerging market than it is maybe
a fully developed one.
Be primary care when we are.
Farther in the Southeast it'smore of an emerging market than
it is maybe a fully developedone like you are.
(19:13):
So it feels like it's driftinginto its heyday, whereas there's
a lot of cobwebs on thesurgical specialty with an ASC
hunk of the world very stuck infee-for-service kind of spiral.
Fast forward me and y'all'smarket to what that looks like.
Is it still, you know?
Is it a good day to be aprimary care in a more mature
(19:37):
market like that?
Sherry Roussarie (19:39):
I mean the incentives for primary care
physicians today, this wholeemerging and rapidly growing
Medicare Advantage.
You know, insurance populationis where they have opportunities
.
It's where primary care hasopportunities to generate
additional income.
So it is making a bigdifference and that's why you
(20:00):
see all kinds of startupsgetting into that business and
partnering with independentprimary care groups to help them
build the infrastructure to besuccessful in that environment.
You are disincentivized in thatmodel having specialists.
They only hurt you, right?
They add cost and that kind ofthing.
(20:20):
So, yes, I think so it is, butI'm not sure it's enough, quite
frankly, because without,without, you know, the startup
companies that you know willprovide the population health
infrastructure and you know, cando the aggressive, you know,
pair contracting side of it.
(20:40):
They take the majority of theincome.
The clinicians still, you know,benefit from that, but it's,
yeah, it's, it's tough.
And then on the specialty side,benefit from that, but it's,
yeah, it's tough.
And then on the specialty sideand I don't think it's changed a
lot in the last couple of yearsyou know the hospitals are
replacing the specialists withtheir own employed, and so
that's, you know, that's, thatis the challenge on that side of
(21:02):
it.
But, yes, there is someincentive for primary care
Currently.
I'm just not sure it's enough.
Julia DiGiacomo (21:10):
We'll be right back.
Did you know?
Shp provides cradle-to-gravemanaged care contracting
services.
Shp offers comprehensivemanaged care contracting
services, from contract languagereview to reimbursement rate
analysis.
We address charge level,clinical coding, billing and
appeals to optimize overallreimbursement.
Don't let aging contractshinder new services or locations
(21:33):
.
Be proactive with SHP managedcare contracting.
Visit shplccom for details.
Jason Crosby (21:43):
I kind of want to pivot.
I know we've talked about payermechanisms, payer reimbursement
all day and the impact it's gotKind of shifting to more recent
headlines, I guess you couldsay and disruptors that you see
not just on the retail side, butAI.
Everybody's reading everythingabout the impact of AI.
We've interviewed some in thecare management space as well
(22:05):
and it's pretty interesting tohear where they see things going
.
What do you guys see inparticular in the independent
practice side, where maybesomething like AI or any form of
automation and technology couldhave an impact on the practice
for an independent practice?
Kelly Macken-Marble (22:23):
AI covers.
It's such a broad category.
It's such a broad topic and thefirst thing that I think of
when I think of AI in a medicalpractice is a patient showing up
with their AI generated.
Here's what I learned about mydiagnosis.
(22:44):
So, doctor, here's how you'resupposed to treat me.
I think there is certainlygoing to be more of that kind of
thing because as it gets easierto access that information and
come in with it.
But certainly a caution to allof us healthcare consumers be
careful.
We know that those mistakesexist within AI and that's not
(23:07):
something that we're going towant to go in and tell the
physician how to practicemedicine.
I think the practices have someopportunity with AI and how they
use it and can capture perhapscertainly spitting out
(23:29):
information about a patient'sdiagnosis and treatment and
those sorts of things and whatthey can do with it.
It could be very beneficial forthe treatment of patients and
the aftercare and those sorts ofthings with the patients In
terms of how to manage withinthe practice itself.
(23:49):
Are there ways that we coulduse AI to determine how the
payers are paying us?
Are we getting paid what we'resupposed to get paid?
What are the clawbacks doingthat are happening from the
payers and can AI help us to bemore efficient and better at
(24:11):
determining that sort of thing,which could generate millions of
dollars for a practice of whatthe health plans actually
underpay them.
So I think that's a reallyopportunity in that arena to
gather data and information andhelp to benefit the practices
(24:31):
through AI.
Sherry Roussarie (24:34):
Yeah, I agree, sherry and I had a chance to
listen to a radiologist speak tosome of the AI functionality in
that particular specialty andit's phenomenal.
And there are some specialtiesthat I don't know.
I mean they're getting reallyreally hard to recruit.
(25:09):
You know any of the internalmedicine subspecialties
rheumatology, endocrinology,really any of them.
And so if there's any portionsof that that, can you know?
Ai can make a difference justreading images.
You know that's helpful, thatfor radiology specifically,
that's becoming pretty advanced.
It'll never take the place of aperson.
They were careful to you know,call that out.
But I think there's lots ofopportunities on the
(25:29):
non-clinical side.
So much opportunity for expensereduction.
You know what I'm hearing rightnow, like in the space of
health information managementautomating.
There's a lot of it that'salready been automated, but with
AI even more.
And so there are a lot ofhealthcare companies looking at
(25:50):
how they may be able tocompletely eliminate or
outsource HIM.
That's one area.
Revenue cycle there's a lot ofautomation and payment posting
and things like that already,but Epic, for example, is
working on building in more AIinto its software.
(26:12):
So there's going to be a lot ofefficiencies gained and may
help reduce overhead in a lot ofthe administrative areas.
Mike Scribner (26:20):
Can I go back, kelly?
You know as a lot of these sortof the wave of change as it
relates to physicians in general, independent physicians and the
alternatives that they have inmarkets have come at you now
sitting back in the seat ofhospital administration.
How does that make you thinkdifferently now?
(26:41):
Because you go back severalyears ago there was either
employment or there wasindependence.
Now there is value-based,enabler-tied independence.
There's corporate medicinequote-unquote independence
there's so many other flavors ofthat.
Now.
Medicine in quote unquoteindependence, there's so many
other flavors of that.
Now.
How does that make you have tothink differently now as you
(27:03):
look at your not employed but inthe morass around you market?
Sherry Roussarie (27:07):
Yeah, I mean I think the addition of private
equity into supportingindependent physicians does
bring a different dynamic, butnot necessarily a negative one,
and I think that's unfortunately.
(27:28):
I think there's a belief thatwith that evolution the focus on
the cost of care will go up forthose clinicians.
And I don't.
And I haven't seen that as Ihaven't read evidence of that
and I do look for that because Ihear it a lot.
Cms actually did some work onthat and there is no evidence
(27:50):
that that's really the case.
But now that I've been removedfrom the market that Sherry and
I were in and I'm in where I'mat, I feel like it's not any
different.
Right, it's the same.
It is the same as it was thereand really is in lots of places,
most places across the countryis it really is still health
(28:12):
systems versus independent,whether the independents are
backed by private equity.
The Minnesota market has a lotof very large independent
specialist groups that areprivate equity backed and they
pose quite a challenge for thehealth systems they do and in
(28:35):
the market I'm in right nowthere's actually a fair number
of independents left, one inparticular in right in my
immediate market.
That is a challenge for thehealth systems and you know I
feel really compelled to supportthem.
So yeah, I think back 30 yearsand I think about where things
(28:56):
are at today and sadly, not alot has changed.
I mean, you still really havethe choice of independent and if
you're independent, you've gota few other levers to pull, like
private equity and MedicareAdvantage.
You know contractingopportunities, which is a great
way to bring in some.
Kelly Macken-Marble (29:12):
You know additional income, but I'm not
sure Sadly, you know, a lot'schanged that way and Kelly's
(29:34):
view of independence, of beingable to lower the cost of health
care overall for the healthsystem by using what already
exists in the market with thesehigh-quality providers and you
don't, as the health plan, havethe cost of hiring them
yourselves, but then partner andcollaborate with them.
(29:56):
In our market in Indiana that'snot the case.
The hospitals view it that as ifyou are not working for us,
then you're working against us,and if you do not become
employed by us, we will employphysicians, no matter how much
(30:21):
this duplicates what alreadyexists in the market, because we
want to control that entiresystem and throughput of the
services, whereas thesephysicians had historically, or
since the beginning ofhealthcare time in South Bend,
(30:42):
had these two hospital systemsthat were the same physician
groups that serviced both, andas the competition at the
hospital levels grew, thehospitals felt like they had to
own everything and so it's adifferent.
I think it's still market bymarket as to what that looks
(31:05):
like, and the collaboration thatKelly is talking about is
absolutely right on target.
There's a place at the tablefor all of us place at the table
for all of us, but the healthsystem needs that vision and
(31:25):
those eyes to see how much theycan save by using some of that
existing.
And then they fill in the gapsin the areas where some of those
harder to recruit services sayyou know, urology might be a
difficult one to recruit, for itis across the nation.
Perhaps they would look therethat kind of thing where the
(31:46):
groups themselves, theindependent groups themselves,
are struggling more.
So we'd like to see that moreof what Kelly's talking about go
in through the rest of the US.
I think that's missing somewhat, certainly in our north central
Indiana area.
Mike Scribner (32:05):
Sherry blunt, assessment of the previous
market, the freedom ofretirement right.
You get to just say it the wayyou feel it.
Aaron C Higgins (32:14):
Beautiful thing isn't it?
Mike Scribner (32:28):
But let me flip that discussion around through
the eyes of the employer.
How have you seen that evolveover time?
Sherry, available, but go backfor both of y'all.
Go back 15, 20 years ago.
How have their requests, needs,models changed and how you
wanted to interact with themfrom a provider perspective?
Kelly Macken-Marble (32:55):
I think the employer's perspective has not
changed all that much andthey're looking for low cost,
high quality care.
They want to make sure, theywant to ensure that their
employees are well cared for,and what we are seeing and
experiencing now in many marketsis the insurer, the payer, is
(33:20):
now saying yes, of course, thispractice is in network and your
employees have access to thisbroad network of providers.
However, when the employee goesto access those services, a
physician within a larger groupmay not be included in that they
may not be covered in thatnetwork, and then, or a location
(33:47):
of that same practice may notbe covered in that payer's
network.
And so the employers are beingsold these broad networks that
can service their employeesthroughout a region and yet when
it becomes operational withinthose patients seeking care,
(34:11):
it's not available.
It's not available and it'sbecoming more and more difficult
.
It's starting to look to melike much like the HMO market
looked like in the 1990s andwhere you really had to be very
involved with your healthcare tounderstand what it was that you
(34:33):
were getting.
You can't just pick up yourprovider book and say I'm going
to go over here to see whetherit's this primary care or this
cardiologist, because thatparticular one may not be, even
though their entire practice isin.
Mike Scribner (34:45):
Kelly thoughts.
Sherry Roussarie (34:47):
Yeah, no, I was just laughing inside
thinking about how much back tothe HMO sort of feel as we were
in the 90s.
I mean it is very much thatmarket today.
I feel like you know it happensregularly that a group is in
but one or two doctors are out,and so it's complicated for
(35:10):
patients to manage.
But yeah, no, nothing other toadd.
Jason Crosby (35:16):
All right, like Mike mentioned, we tend to ping
pong our questioning back andforth, so I'm once again going
to pivot left, this time Kind ofbacking up.
You both have held numerous CEOroles, very successful,
different markets, differentsettings.
How, in the past, have youmeasured yourself as a CEO and
or the organization?
(35:37):
While as CEO, how did youmeasure yourself in the
organization, on you know as youwere moving along to your
success?
Were there certain metrics,certain you know, as you were
moving along, how did youmeasure yourself?
Kelly Macken-Marble (35:53):
Yeah, go ahead, sherry.
Well, you know, I think theythey're the standards.
You know you have yourfinancial viability and all the
factors that go along with that.
You have your physicianretention, your employee
retention.
All of those are those piecesthat we all measure, whether
(36:16):
it's in healthcare or inmanufacturing, in retail.
Those are the basis, those arethe standards.
I think where we really get intoit and where the fun is is when
we break a few eggs.
(36:37):
I think the most successfulorganizations are those that
really step into innovation andthey really embrace the idea of
change or to try new things, orto perform the old things in a
new way, and to take those risks, to step out and say let's try
(37:00):
this innovation.
Some of it's going to work,some of it is absolutely not
going to work, but these are thethings that really help to move
an organization forward.
And I've had the fortune, I'vehad the opportunity to do some
of those things in my careerhere in the South Bend area and
(37:24):
they were exciting and they werefun.
Some worked, some didn't, butat the end of the day, more
worked than those that did notand you see it in the result of
those typical metrics that youlook, you have the financial
viability, you have the employeesatisfaction and the physician
(37:46):
satisfaction and the retentionof those things that come along
with doing the things that areexciting.
But again you have to break afew eggs.
Sherry Roussarie (37:55):
I love the way you described that, sherry,
breaking eggs.
That's good, I agree.
I mean there are some standardmeasures right that we all look
at and I'm accountable to aboard for, you know, to be
successful, the typical sort offinancial measures and patient
experience measures and thingslike that I'm also a big
believer in.
For me, the most importantmeasure for me is around how my
(38:18):
employees feel.
So if they, you know, if youhave a team that feels valued
and engaged, everything elsejust gets better.
Right, your financials arebetter, and there's lots of
studies that have been done tokind of show that.
So I spend a lot of time onthat and on culture, and if you
know I'm successful there.
To me that's a huge win.
(38:40):
But so much of the work today isto remain viable.
You know we live in a worldwhere big health systems are
losing money and struggling tostay financially viable, and so
you know, a large part of thework is what Sherry did is said
(39:01):
so well is about how do we beinnovative, how do we do
something different to help keepthe organization viable and,
you know, be a value to thecommunity and to your patients.
So it's, you know, you've gotto be willing to think a little
(39:22):
bit different and you know I'mnot one to get caught up in
market share and sort offighting over that kind of thing
.
So I keep my team reallyfocused around what is our value
proposition.
You know what can we bring tothe community that not only will
take care of their sort of, youknow, basic primary care needs
and emergency needs and thingslike that, but you know what can
(39:44):
we also do in terms of serviceand support that will help us
ensure we're going to be here in10 years or 15 years.
So so much of the work isaround that.
So I do feel a fair amount ofyou know my role today and my
energy and time is the strategiclens of you know what is the
marketplace need?
What are we providing today?
(40:04):
What do we need to do differentto ensure that financial
viability and, you know, mostimportantly, be a value right to
the community?
Jason Crosby (40:16):
So I think that's a fair amount of the work
Fantastic.
That kind of dovetails nicelyinto our conversation I know
that we'll have tomorrow.
We kind of dive deep intoy'all's perspective in terms of
leadership.
It was a great conversation.
I appreciate you guys giving ussome perspective from the CEO
seat.
I know we're going to haveanother deep dive conversation
into the book Two Rivers thatyou guys released just last year
(40:39):
, right March or April of 23,.
Is that right Fantastic?
And we'll have a couple of newSHPers well, not new to SHP, but
new interviewers on for thatpodcast and we'll record that
tomorrow.
But appreciate you guys doingour podcast today.
Thanks again.
Sherry Roussarie (40:56):
Thank you.
Thank you so much, you guysdoing our podcast today.
Thanks again.
Aaron C Higgins (40:58):
Thank you.
Thank you so much.
This has been an episode ofBeyond the Stethoscope Vital
Conversations with SHP.
If you enjoyed this podcast,please be sure to rate and share
it with your friends.
Jason Crosby (41:11):
It sure helps.
The show.
Production and editing by NalaWeed Social media by Jeremy
Miller.
Aaron C Higgins (41:16):
And our co-hosts are me, aaron C Higgins
and Jason Crosby.
Our show producers are MikeScribner and John Crew.
Jason Crosby (41:24):
Thank you for listening and we'll see you next
time.
So our most important questionI need you to really focus, get
ready.
When Mike and I first met youguys, we had a lot of fun of the
you know two southern guyscoming up north.
We were scared how much snowand all that.
So I gotta ask you're thirsty?
(41:45):
You're going into a restaurant.
All they have are soft drinks.
Are you ordering soda or pop?
Kelly Macken-Marble (41:52):
I'm ordering coke.
Jason Crosby (41:55):
Southerner right there Okay.
Sherry Roussarie (41:58):
Pop Michigan.
Yes, that's all we called it inDetroit.
It was Pop, yeah, yeah for sure.
Jason Crosby (42:05):
Yeah, erin is our resident Northerner, since
Trenna is not with us.
Who are Minnesota Minnesota?
Mike Scribner (42:13):
Yeah.
Jason Crosby (42:14):
Minnesota.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
The Breakfast Club
The World's Most Dangerous Morning Show, The Breakfast Club, With DJ Envy, Jess Hilarious, And Charlamagne Tha God!
Crime Junkie
Does hearing about a true crime case always leave you scouring the internet for the truth behind the story? Dive into your next mystery with Crime Junkie. Every Monday, join your host Ashley Flowers as she unravels all the details of infamous and underreported true crime cases with her best friend Brit Prawat. From cold cases to missing persons and heroes in our community who seek justice, Crime Junkie is your destination for theories and stories you won’t hear anywhere else. Whether you're a seasoned true crime enthusiast or new to the genre, you'll find yourself on the edge of your seat awaiting a new episode every Monday. If you can never get enough true crime... Congratulations, you’ve found your people. Follow to join a community of Crime Junkies! Crime Junkie is presented by audiochuck Media Company.