The "Yap" Answer

I view one of the most important roles of the CEO as that of the chief questioner. There are deep assumptions that people rely upon when they make decisions that are often irrelevant, outdated, or illogical. Until you start asking questions, no one will look for new answers. Can we do it better? What is the customer point of view? Can we strip this down further and simplify it? I advocate for the customer. Whenever anything is presented as obvious, is question, push, and encourage people to really think of how we do things based on what our customers need and want.

I have a term that I use whenever I hear someone offer a response to a question or propose a solution that hasn't been well thought through, or researched or considered.  Everyone knows it when they see it - a flip answer without the hard work of digging in, getting the data, working through the options, running the scenarios.  A "yap" answer.  No one likes to say to their boss or peers that they don't know or haven't done the work to get to a well considered answer so they fall back on "yap."

At the end of the day, human judgement, creativity and ingenuity will make the difference in making a decision, but the hard work to clarify your thinking, to understand the potential unintended consequences, to lay out where things may go wrong; is critical to the process.

A good leader practices accountability and visibility...starting with themselves.  And accountability starts with rigorous thinking.   I work to hold myself to the highest possible standards and expect others to do the same. When mistakes are made, I am the first to own them... trying to take the fear of out accepting responsibility for others.  Mistakes aren't fatal but "yap" answers are. 

Integrity, first and foremost, is essential in an organization. There must be integrity in our actions, our words, our treatment of individuals, and our treatment of partners, clients and the community.  And in our commitment to rigorous thinking.  You have to work hard every day to avoid the trap of "yap."

Culture can be a competitive advantage.  A positive, dynamic culture is critical to achieving the sort of momentum and movement I described in my prior post.   Even more important than any particular project or metric, a CEO needs to tend to the culture of her company, to make sure that it is a force for good.  Crafting and nurturing the culture is one of the most important goals of a CEO. At MDeverywhere we focused on creating a culture where  transparency and accountability was valued across the organization.  Where performance was the first and final arbiter.  Becoming a purely performance-driven organization is a journey where the goal post is always moving. There is always more to do as you protect against stasis and dilution.   We started with a value statement crafted to clearly delineate the values that defined what it meant to be an MDer. 

Core MDeverywhere Values:

Ethics

Candor

Rigor

Exceptional Quality

Intellectual Curiousity

Excellence

Sharing

Creativity

Service

The most important job of an organization's leaders is to help every member of the team live and breathe these values and demonstrate them every day. At MDeverywhere, we worked hard to make sure that we only had the best people and that we gave them the freedom they needed to accomplish great work.

Hiring was a rigorous process as we took seriously the responsibility to ensure that every MDer was surrounded by colleagues that were exceptional at what they did and who made us all better as a result. At MDeverywhere, performance was the only yardstick and excellence the only acceptable standard. Achieving this often meant making tough people decisions at times. It  also meant achieving exceptional success.

To reinforce these values, we made two key changes in our HR policies. We abolished our PTO policy and replaced it with a discretionary policy. As we were only focused on measuring outcomes, we got out of the tedious business of tracking and monitoring how people spend their time. All individual and team goals and deliverables were stretch by definition and accountability to achieve them non-negotiable. With that as the standard, every member of our team was given maximum control over their time. It wasn't about how many hours you worked, or even how hard you worked; it was only about what you accomplished.  I believe strongly that we don't pay people for their time or even for tasks but for accomplishing the outcomes and goals that are important to the company.

We instituted an MDe Elite award - a peer and client-nominated award to cheer on exceptional performance. The quarterly prizes were significant and the annual award sought after.  

All of this helped MDeverywhere punch way above our weight as an organization.  We were able to attract and recruit exceptional people as we became a destination employer.  People loved working for a company where politics were not tolerated.  Where people were respected and treated as adults.  Where expectations were clear and called for the best in people.  Where people could expect to be surrounded by people they were proud to call peers.   I know that I was proud to be part of a high-performing team where everyone took such pride in their work and in our Company.

The MDeverywhere Chapter Part 2 - Newton's Laws of Motion

One of the most interesting learnings from my time as CEO at MDeverywhere is the power of momentum. Positive change begets more positive change. Once you reach a critical inflection point, the pace of progress accelerates to an exciting level. That is the "zone" where you have broken through inertia and the expectation and excitement of success and forward movement builds on itself to the point where exceeding goals becomes the norm.  

In my last year at MDe, we launched more than 50 new versions of our market-leading revenue cycle system, Practice 1st, including a game-changing version that included many new features/benefits. Practice 1st 4.0 included enhanced My Lists and Division Lists, Pre-Auth Appointment Types and Edit added on Appointments, Optimized Mobile Experience and an Improved User Interface. Customer feedback to the system updates was through the roof positive. Continued development of our online customer onboarding portal, Client 1st, added many new features. While EKOS, the proprietary work management system, experienced major leaps forward in incorporating refined work queues and enhanced reporting and monitoring of additional work streams including pre-bills. We launched Patient 1st Communicator incorporating text and email appointment reminders for patients and adding much tighter integration with Practice 1st. We launched an online training portal to help our clients prepare for ICD-10. These online courses were specialty-specific, proctor-led and designed to be rigorous as well as flexible. Finally, the transition to a new clearinghouse offered much greater flexibility and visibility in our claim submission processes.

Our marketing efforts showed tremendous progress in establishing MDeverywhere as the thought-leader in physician revenue cycle. We distributed over 1 million emails with value-added content and information and hosted webinars attended by more than 5,000 prospects. This was done leveraging new marketing automation and content curation tools and systems. These efforts resulted in a dramatic increase in online leads coming both through native web searches as well as click throughs. Content creation became a major strength with a daily blog of comprehensive industry content, a weekly newsletter and numerous topical white papers. 

Perhaps our biggest shift in operations came in instituting a 5-day turnaround on resolution of denial ANSIs. Bringing all of our focus and resources to the rapid resolution of denials on the front end instead of working AR on the backend, ensured that cash came in quickly and receivables neared zero. We were also better able to identify trends quickly and put in place strategies and rules to mitigate.

And all of this progress translated into tangible financial success with operating metrics all continuing on a positive and accelerating trend. MDeverywhere had reached a point where we were not only hitting industry benchmarks but were SETTING industry benchmarks. The clean claim rate and collection yields were higher than any known competitor as we focused continually on reducing denials and increasing automation. And of course, this had a positive impact on overall profitability as EBITDA margins increased 33% year over year as a result.

And clients also noticed as significant revenue from existing clients bolstered our top line. Additional business from current customers is the the best signs of all of high client satisfaction!

Not to say that any of this was easy but what is now very clear to me is that Newton's law of motion work the same way in a company as they do in the lab...

• An Object that is at rest will stay at rest unless an external force acts upon it
• An Object, once in motion, will stay in motion!

The MDeverywhere Chapter

I'm Ann Bilyew, the former CEO of MDeverywhere and I am going to open my blog about my leadership journey with something I am very proud of and something that a great many incredible people had a hand in - the building of MDeverywhere into a significant company and a leading healthcare revenue cycle company.

The history of MDeverywhere is the history of a Company that has been built on a culture of innovation, customer service and rigorous execution.  

MDe actually started out as two separate companies - one a traditional, paper-based medical billing company and the other a technology company that had developed state-of-the art tools (originally built for the Palm Pilot!) to automate the charge capture process for physicians.
 
While a partner at Advent International - an investor in both companies - I merged these two companies to create one of the earliest technology-enabled service companies in healthcare.  The premise behind the merger was a simple one - the technology company (MDeverywhere) had developed very elegant tools that helped bring rules and intelligence to the front end of the revenue cycle while also reducing the need for manual data entry downstream.  The service company (Med eManager) had the back office capabilities to manage the complete revenue cycle on behalf of clients and the recurring revenue model that could lead to sustainable, predictable growth.  It was a fledgling company - a raw start up - with a few people, some great technology and a vision to bring automation and efficiency to what was a very staid and inefficient but important process.  So then we set about to work.  That was really the birth of MDeverywhere as it is known today.


There have been many milestones since that day in 2003 and today and I will take the time to mention only a few.
                                                  
We opened our facility in India in 2005.  At the time - and even today - that was a very audacious thing to do for a young, small compay.  We took this big step because we wanted complete control of the end--to-end process and saw the potential in India to build a state-of-the-art facility staffed with ambitious, smart professionals who were excited about building a career in healthcare revenue cycle.  Many companies "outsource" parts of the process to third parties in places like India or the Philippines but we believe that the best way to provide a consistent service to clients is to control the entire process including who we hire, how we train and how we design and automate our processes.   We started with 28 people in a small facility in Noida.  In 2014, we moved into our third facility and had more than 250 people working hard there everyday on behalf of our clients.  That number is now up to 450. This processing center is a shining example of the big bold steps that went into building MDeverywhere.

In 2008, I went from being a board member and investor to being the CEO of MDeverywhere. It was an opportunity for me to fully lead a company that had tremendous potential but had failed to live up to its promise. And from there, we set about changing everything. First we started with sales - restructuring the sales force, the marketing message and the selling and lead gen models. The results were immediate with an substantial increase in yield on our sales spend and a 5-fold increase in productivity. We restructured operations into multi-functional teams built around clients and created incentive structures based on client performance. We changed our Account Support model to instill greater visibility and accountability around client communication and satisfaction. Basically everything was changed. There was some resistance to the changes and not everyone made the leap to the new day. Not everything we tried worked and we had to make some course corrections along the way but I am happy to say that the overall results have been tremendous as measured by all metrics.

In 2011, we embarked on a major development initiative to update our front-end platform for clients.  Building a purpose-built RCM system from the ground up - Practice 1st.  Designed out of the gate to bring all the right rules and capabilities to the beginning of the revenue cycle. It it all begins at the practice and with the patient - that is where data integrity is both so difficult and so critical.  Practice 1st is special - it is special because it is built with one thing in mind - successful adjudication of a claim.  While streamlined workflow and an intuitive UI are also important measures of a system, our team designed Practice 1st as a smart workflow tool that ensures process control as appointments are made, demographics confirmed and encounters coded.  Practice 1st was launched to rave reviews.            

Also in 2011, MDeverywhere made a strategic acquisition to bring physician Credentialing to its offering.  We acquired AHMS, a boutique firm with a highly trained team of professionals with deep experience and knowledge in the credentialing process - including the relatively new process of delegated credentialing or CVO.    The Credentialing business unit quickly became an important stand alone business as well as a service offering available to all RCM clients.  

In 2013, MDe had two significant milestones - the partnership with Henry Schein MicroMD and the launch of Patient 1st.  There is no question that meaningful use incentives and the resulting widespread deployment of EMRs had a major impact on our industry over the past few years.  While MDe maintained the ability to interface with most third-party EMRs that a client or prospect selected, The partnership with MicroMD was an important one - enabling the Company to offer an integrated EMR/RCM system/RCM service product to the market.   

That year the company also launched a new comprehensive Patient Pay platform designed to streamline the collection of the rapidly growing patient responsibility for payment of medical claims.  This comprehensive tool incorporated automated messaging, point-of-care payment solutions, estatements and online payment capability.  Our goal was a simple one - to make it easy for patients to understand their financial responsibility and easy for them to pay it.

Other recent innovations include development of a billing support team in the operations center that supports clients via online chat, deployment of a comprehensive workflow management tool, EKOS, to standardize and add transparency to our claim resolution process, the launch of Client 1st as a online implementation portal and development of a number of tools to facilitate and automate EDI processes.  And the launch of MDeU, a full-scale knowledge platform.  With MDeU, we leveraged our team's collective knowledge and experience to ensure that our team and our clients always had access to the latest information about our products and services and about the business of healthcare.

Over this time, the company also grew significantly and expanded from a regional company serving our NY/NJ base to a company with a national presence. From processing $150 M in annual claim volume to processing >$1 B a year through its systems. From 45 to 650 employees. From docs numbered in the hundreds to more than 20,000. in 2015, the Company merged with eMDs, a company with a market-leading EMR to create the fully-integrated clinical and financial product offering that is required by practices today. That merger was the final step in Book 1 of building MDeverywhere.

We did a great deal over the years - building new products, building new capabilities, designing new processes.  It was a terrific journey and one that I am proud to have led. We touched many lives, helped many practices and created opportunities for many people. That is what building a company is all about.