board update 1.7.23: bts at advaita health
What follows is an email I sent to my board of advisors moments before posting this blog. Why would I share this? Well, reflection is essential for my own learning, plus if I can help others avoid some of the mistakes I’ve made, then I’ll be happy. A few things to note prior to reading: I have an overly qualified board, and when we went through the rough patch last year, I quit communicating regularly — very unprofessional. We’ll see who all sticks around…
I established the board mainly for philosophical reasons — I believe that regardless of how talented and experienced you are, you could always use “adult supervision,” lest you drink your own Koolaid. Too many entrepreneurs espouse noble missions only to end up acting recklessly (ahem, SBF). Right now, the board has no formal role in governing the Company; however, I plan on changing that. The need to formalize the legal structure, governance, and board compensation (i.e., options or cash) has been a year-long issue. They’ve been patient with me to date, but that’s going to wear thin at some point.
Board Members,
Hope that everyone’s new year is off to a great start. I’ve spoken to most of you individually regarding my lack of communication and the path forward. You are all busy, overqualified folks who I’m lucky to have in my network, and I do not take your time for granted. I will provide a biweekly update, and the board's structure will be codified over the coming months. If I haven’t talked to you individually, I’ll reach out again following this email. If you’d prefer to take a step back, I completely understand.
Most important update: Alan has an AIM email address, which means I’ve gotten tremendous help in professionalizing the company. We’re scoping out the extent of his engagement, but the team is already grateful for his steady hand and clear thinking.
Finance update
Finance and revenue cycle management (RCM) has tripped us up for the past year. After terminating TGG Accounting, I reached out to our tax accountant at Thomas Judy Tucker Accounting (TJT), and he connected me with their new strategic finance consultant. Our finance “department” is still a hodgepodge of folks making various individual contributions, and we’re without an experienced quarterback, but it is moving in the right direction. Starting this week, we’ve got a monthly finance meeting to review the P&L and balance sheet, which are due on the second Monday of the month. I’ll be sending out financials during my mid-month update going forward. Below are the past month’s accomplishments.
We’ve updated our chart of accounts on the income statement, forecasted and budgeted for Q1, and disseminated this information to all department leaders.
Our new bookkeeper is largely up to speed after taking over in the middle of December.
We added a member to the RCM team, and we’re making major strides in collecting receivables as quickly as possible.
Legal & governance
I purchased my former partner’s shares of Advaita Health Ventures & Green Hill Recovery with just hours remaining in 2022. You all have made it crystal clear that the legal and governance needs to be professionalized. This was step one. Step two is completing an F-Reorganization, as Green Hill is an S-Corp. That will be completed by the end of January, and then I can turn my attention to the legal structure of the board. I understand that patience has worn quite thin…you’ve only been telling me to do this for 12+ months.
Marketing & business development
I’m making a bet on digital marketing this year. I’ve cut the business development budget in half and allocated that money to digital marketing, primarily search engine optimization. Most of our new patients that aren’t referred find us online. We have engaged with Active Marketing, whom we worked with for the Green Hill website a few years ago. We have good KPIs in place to measure the effectiveness of the engagement, and I’m heavily involved in managing the relationship.
On the business development front, we are focused on increasing the census in our managed care programs (IOPs and TMS). Our local presence is focused on primary care, therapist, and psychiatrist referral partners, and our national presence is focused on residential treatment centers. This week, we’ve got an offsite to dive deeper into the KPIs and strategy.
Our patient pipeline is the strongest it’s been in the past year. Seems like 2023 is off to a strong start.
Operations (clinical + medical)
Due to the holidays, December is always a weird month for utilization, and this year was no different. We still have a lot of work to do to set and enforce clear, manageable expectations and hold individual contributors accountable. That said, we’re making major strides in timely reporting and accountability conversations. After almost two months without a clinical director, I’m thrilled to have Corey Kennedy stepping in. She’s got her work cut out for her, as the complexity of our operation compared to this time last year is about 3x.
The next month or so will be spent doing a deep dive into the basics of providing high-quality care. We are looking at the patient experience from initial intake to discharge and updating policies, curriculum, and training manuals. By the end of Q1, I expect we will have a well-oiled machine that delivers world-class, evidence-based patient care. As Alan has beaten into our heads, “variation drives cost,” and I believe that variation also leads to quality control issues. We’ve got a robust training calendar set to ensure that we are on top of best practices and that each member of the team has been set up to deliver excellent, individualized patient care.
HR / People
We are in the process of onboarding eight new therapists from our clinical director’s private practice. This will allow us to better meet the needs of our current AIM patients while offering new services in the Cary location. In addition to adding new team members, we are updating the compensation plans to better align incentives. While the expectation for clinical team members has not changed, the new compensation structure will be “base + productivity,” allowing all individuals to earn more income if they meet the existing expectations.
Insurance contracting
We’ve received our Veterans Affairs Community Care contract, which goes into effect in February. Additionally, we’re credentialed with Tricare and we’re moving forward with the contracting process. As a veteran, it’s important to me that we are able to serve active duty service members and veterans. This is a big step forward in the process. Maybe one day we’ll have a veterans-specific treatment track…
Personal / CEO Corner
Who would I be if I didn’t have a bright, shiny object to chase? Most of my energy should be (and is) dedicated to becoming a better operator-CEO, but I love the external-facing stuff as well. One of my personal goals this year is to consistently scratch my creative itch, so I’m spending some of my time writing about leadership, life, and my contemplative journey on my blog. What does this have to do with the business? A lot, I think. My philosophy permeates all that we do. I seem to have a knack for recruiting and building a values-based culture, and the content I’m producing helps keep us top of mind for future team members and referral sources, plus it’s just fun for me. I’ve already had a few VIP folks reach out after reading, so there’s that. I hope to shape healthcare policy in the future, so I better start building my body of work now, right? Here are my reflections on 2022.
Numbers of narrative – that’s what I keep telling myself. You’re going to see the nature of my updates change dramatically in the coming weeks. I’ll be leading with numbers and adding color.
As always, thank you for your time and support. Full steam ahead!
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