Hello, everyone, and welcome to the Medaxium Strategic Planning webcast. I am joined today by my colleague, Ginger Biesbrock, and my name is Joel Sauer. I'm the EVP for Consulting, and Ginger is the EVP of Care Transformation, which oversees our consulting operations. Thank you all for taking the time to be with us. We have a lot of content to cover here, so we're going to get right into it. We're using a Zoom platform, which is hopefully pretty straightforward. We'll use the chat button that you should see somewhere looking like the screen you see in front of you now. There's a chat icon at the bottom. That is where you can find our slides, and you can download those as a PDF. And then because we're on an electronic platform, we'll use the Q&A to answer any questions, and you don't have to wait until the end of the presentation, the formal presentation. You can ask those at any time. We will answer them then at the end and also open it up for some live question and answer as well. Any technical questions that you have, please use the chat feature. We have MedAxium personnel monitoring that and to help you out if you're having any problems with audio or visual. Let me start off by saying with strategic planning, using a Lewis Carroll quote, if you don't know where you're going, any road will do. And we find that so pertinent as we have traveled the country as consultants and seen high-performing programs and what delineates those from those who don't perform so well. And you see it on this slide at the very bottom. It's a bedrock foundational element. They need to know what it is they're trying to do. And that knowledge, that understanding of what that vision is doesn't just reside in the top levels of leadership. It emanates and is understood all the way down to the bottom of the organization. So having that is absolutely critical. If they talk about that elevator speech, if I have eight floors and an elevator with someone, can they explain to me what it is their organization is trying to do? If they can't do it in that time, then it probably isn't as well understood or communicated as you might think. So really spend the time to put together that very well-defined and articulated vision. The math around communication is mind-boggling. If you're a larger organization, you're pretty much going to have to be in perpetual communication mode in order to make sure that that is getting to all corners of your organization or your company. So make sure you're really, really communicating that. And then you can see these other, no MedAxiom presentation is complete without this slide. We use it a lot because it just has proven so reliable in terms of what it takes to deliver high-quality patient-centric care. I'm going to start off here with going through some of what's happening at a macro level across the country that is impacting our cardiovascular programs. And then we'll get deeper into the strategic weed, so to speak, on how you may pull off strategic planning for your organization and how to make it meaningful and impactful. Got to start with artificial intelligence. It is nearly every day that we're hearing something new that has been impacted because of artificial intelligence. And that game kind of changed late last year when ChatGPT, ahead of almost everybody else, announced or made public their AI platform. I use it regularly. In fact, Ginger and I used it to put together the presentation you're seeing right now. It is an incredibly powerful tool, cannot be used without thought and without back support. However, it is going to impact health care. There's just no doubt about it. We're seeing it a lot in the imaging areas and other aspects of our daily lives. Revenue cycle, very, very large. So the big question is, are you at the table or are you being served up on the menu? We all need to learn how to use AI in order to survive. There are also very, very big players that have been making impacts on us. Optum is the largest employer of physicians in the country, who also, by the way, is an insurance company. So they're on both sides of the aisle. CVS and then Allidade as well. And I have to mention Best Buy. You wouldn't think of them. You think of them for consumer electronics and appliances. They are actually getting into health care and have figured out how to help providers provide care at home, which is a much less costly place to deliver care. So these places are going after primary care. They're looking to control populations. And then they kind of take away our low acuity, high margin services. They kind of skim the top, particularly when you talk about Optum and CVS delivering care in other areas. We have to be careful that we are also innovating on our sides. And that's where strategic planning comes in. At the same time, we're seeing a growing Medicare burden. That's the lighter blue bar in the middle. It is becoming a bigger and bigger percentage of our total book of business. That's not great because where do we make our margins? We make it on the much smaller percentage that is commercial. That's the dark blue bar on the bottom. And you can see that shrinking over time. Then the light blue bar is also being divided between fee for service, which is the traditional Medicare that we know and understand very well, and managed Medicare, which now just last year passed 50% of all Medicare is in a managed plan. That operates much more like commercial insurance, except for the margins on the business. It's still very much steeped in Medicare reimbursement. And despite this, Medicare has made great efforts to reduce the overall cost of care because as the baby boom generation hits Medicare, it's putting strains on our tax rolls. Despite all of the efforts, we are still projected to go insolvent in just a matter of less than a decade. So the take-home point with that is we need to continue to figure out how to deliver our care in a less expensive fashion because our reimbursement is likely going to continue to be pressured downward, even though our costs of delivering care keep going up year after year. Again, innovation, strategic planning, it all is interwoven. I talked about this, but our Medicare Advantage, look at the players who are dominating the Medicare Advantage space. These are very well-known names, maybe with the exception of the last one, Elements Health, but big, big volumes of patients that when they combine with their commercial roles, they're continuing to put together their leverage over the provider space. So lots of movement here, pointing to the fact that especially our larger provider networks, we're going to have to figure out how to do things more efficiently and more from a strategic perspective, putting in more innovation and figuring out how to deliver care in different settings that lower our overall cost of care. The unfortunate truth is even though this is a Medicare product, there is some level of negotiation that happens with these players. So we're not even guaranteed Medicare necessarily with these populations like we were in the past. As I mentioned, even while our reimbursement continues to go down, and this is now on the physician side, the professional fee schedule from Medicare, the bar on the bottom is what's happened to our rates from Medicare over time, and then the bar on the right top is what is the projected cost of delivering those services, the rate of inflation, so to speak. You can see that delta just keeps getting wider and wider and wider. Not trying to belittle or make everybody depressed. I'm just trying to say there is nothing in the data that would suggest that reimbursement is going to go up in the future or go up faster than the rate of our inflation. It points to our need to continue to figure out how to innovate the delivery of care. Goes without saying, but if you look back to when this trend really started to divide, that was when a lot of cardiologists especially found refuge in hospital employment. Not all that surprising, even if some people were surprised by the outcome of those reimbursement changes. The good news is this. If you want to call it a good news, there is a seemingly never-ending demand for our services. If this was not the case, if we were seeing downward trends in the demand for services on top of those reimbursement challenges, we would be in a world of hurt, but the good news is we have plenty of volume that needs our services and probably more than we are actually getting to. Every indication is that we're going to see more and more demand for services as we go into the future, driven in large part by the aging baby boomers who are hitting by the millions hitting Medicare age, which tends to be where most of 60 plus percent of our heart patients are 65 and older. There's also significant transitions in care happening, fueled in part by artificial intelligence and the digital revolution, so to speak. We are seeing big increases in outpatient surgery, so moving formerly inpatient only services out of the hospital and into the outpatient realm, pushing them either even further into ambulatory surgery centers, obviously also a outpatient point of service or point of care, but not in a hospital in a much lower cost setting of the ASCs. We really saw that in about 2021 when multiple different inpatient only cardiac procedures like PCI were opened up to the ASC. That's been a large driver behind the private equity move that we're seeing more and more. Lots of new home-based care, hospital at home, even ICU care at home, and then office diagnostics being pushed out of the traditional hospital into office settings, et cetera. And then you have the virtual care. We really saw that explode during COVID because it had to. Most are predicting that that is here to stay, and in fact, that we will see about 30 percent of care delivered virtually, if you believe the projections. And Medhaxium data suggests that heart is not moving in that direction. When COVID ended, we saw most of our virtual care disappear and go back to live care. We would contend to you, if that is not a part of your strategy for care delivery going forward in heart, it needs to be. You might want to rethink that. Yeah, what I just said. Here you can see another care transition, this being on the diagnostic side. We're moving from the staple that drove a lot of the private practice revenue in the past, nuclear spec, has lost market share, if you want to put it that way, to CTA. CTA is an amazing technology. There have been explosions in the software and its ability to detect all sorts of things that normally weren't available. There are predictions that it could, in some future state, replace cardiac cath from a diagnostic standpoint. It's getting that good. Those transitions aren't necessarily good for our bottom line. The margin on a nuclear spec is multiples times more than that on a CTA. It's not necessarily us as the providers who are benefiting the most from that. It is the payers, the third-party payers. As we look from a strategic perspective, what are we doing in order to make those kind of care transitions that are great for the patient, but not so great for our bottom lines? How do we make those financially viable as well so that we, as the organizations who are delivering the care, benefit from those transitions as well? All of this is done against a backdrop where we're losing cardiologists in the workforce relative to demand, not just through retirements, but as physicians age. They don't do as many productive units when you measure RVUs. I'm not saying that from an opinion standpoint. I'm saying that based on the data, to the point where if you have 15 cardiologists in your group and you have the normal 25% or over the age of 60, you have a lost FTE in the decline in productivity from that distribution. And again, that's not opinion. That's based on data. Further, the new generation of physicians coming in on the whole and talking generally don't produce as many units as those who came before them. So we have to actually hire more physicians to make up the loss of those who are leaving at the other end. All of that, by our analysis, comes out to somewhere around losing 400 cardiologists a year based on the number who are coming out of fellowship each year. That's a big delta. And remember, back a few slides, we're doing that against increasing demand for services. So we have already had to innovate, and we've seen it in our membership. These are data on how many APPs we have per cardiologist, and you can see it is trending upwards. And there are predictions that that will be over a one-to-one ratio just within a matter of a couple years here based on the trajectory and what we're hearing from our membership. That's one way we're innovating. But again, expanding our care team, seeing more patients with less resources through virtual care and other means is going to be paramount as we go forward, needs to be part of our strategic discussions. Medicare is continuing to innovate. It may not feel like it, and it may feel like they are moving slowly, their forays into value. If you have felt like they feel a lot like redressed or just kind of tinkering on the edges of fee for service, you are right. This was a quote from Dr. Jacobs, who is the CTO for Medicare. He said, quote, we are building muscle memory in fee for service to teach our providers how to succeed in value. He didn't go on to say that the day of reckoning is coming anytime soon, but he was very strongly saying, Medicare is not getting out of value. We are using fee for service programs in order to develop the skills within our provider communities that they'll need. But at some point, we are going to flip the switch over to a value-based reimbursement model. If you look at the care management spectrum of codes and the care management pledge of what they are intended to pay for, they are very much in keeping with that, quote, muscle memory that Dr. Douglas, or Dr. Jacobs was mentioning in this webcast. And by the way, they do have a mandatory bundle in the proposed rule for next year. No longer is there the opt-out if you're not doing well, which was one of the big reasons Medicare was not seeing a lot of ROI from their value programs. The lower performing organizations simply dropped out. Coming next year, there is going to be a mandatory, well, proposed mandatory bundle for cardiac, so coming soon. It's called TEAM, the Transforming Episode Accountability Model, and more to come as more of those details are known. I'll kind of leave you with this. We often get this quote wrong. It is not about survival of the fittest or the biggest. It's about adaptability. That's what, it is those who can adapt that thrive. So when you're talking about strategic planning, it should be all about how do we adapt because the world is changing and we're gonna need that skillset in spades. Ginger. Thank you, Joel. Yeah, so much. And oftentimes we get to the edge of that talk and it's a little bit depressing, certainly daunting. And yet behind all of that is our patients, the value and the care that we provide to our patients. And so navigating through all of that is really, really imperative. So again, thinking about strategic planning, I'll kind of reiterate a few things that Joel already described, but I think it really comes down. I mean, you gotta think about this in a few ways. Number one, he walked through a number of things that we don't have control over, but your awareness and your ability to create a strategy, to react to those things and even be proactive where you can that it starts with understanding. So I've always been a bit of a knowledge is power. You don't even understand what's coming down the pike or the environment that we're living in. So again, the beginning of your strategic planning, laying out the current state is really helpful. Two, figuring out how to control the things you can. So there are a number of things that we can control and how we put our organizations together, how our care is delivered, the way our teams are put together, that you have the ability to strategically tackle some of those challenges. And then finally, the third piece is realizing, and I know we realize this every single day, but we have finite resources. So the more we can plan, understand what those resources are, take into account what we have access to versus what we don't. Those are all the things that strategic planning gives you the opportunity to understand, but also put together a plan in order to manage and lead. So let's take this back a little bit to the beginning. Joel, if you go to the next slide. Number one, we gotta get the right people at the table. So really thinking about your key stakeholders, strategic plan starts with, I don't believe that it's successfully done with an administrator and a physician. Although we're big fans of dyad leaders and dyad leaders is gonna be part of this, you need a broader constituency. You need your leadership team. So if you're working, you're in a CVSL or practice organization, who is your executive leadership team? Those physicians and administrators that have been deputized, if you will, around decision-making. If you've got additional clinical council leaders or medical directors that might lead some of your programs, those are additional good people to bring to the table. If you're part of a larger system, bringing in somebody from system strategy, system operations, system nursing, all of those roles can be very helpful. And again, you understanding what the organizational strategy is and organizational objectives is really important for this. So bringing those voices to the table and then your management team. So if you've got an additional group of people that manage your practice, manage your imaging area, managing your procedural area, this group can be moderately large, you know, eight to 12 to 15 people. You start to get more than that. And it's a little bit challenging to try to bring all of the different, I guess, considerations into perspective. Although that being said, if you're from a very large service line that has regionally based with multiple sites, multiple locations, you may have a larger group that can reach up to 20. So, but thinking about who are those people, who influences, who leads, and starting to pull those people together around the strategic planning event. Go to the next. So again, starting with the basics, Joel mentioned this already. If you think about that bottom row of our organizational hierarchy, if you will, it had to do with vision. So vision, mission, values. And majority of us come from an organization where you may have an organizational vision. I would, Joel and I would both recommend highly that you also develop a cardiovascular program vision. Who are you as a cardiovascular portion of your organization? Certainly it needs to align with the overall organization vision, but that vision, that mission, and I'm gonna go into these here in just a minute, that's your true north in some ways. That's the thing that you're measuring yourself against. When you start to have brainstorming sessions and come up with different ideas for activities and program development and changes, you having that vision in place to bring it back to who we are, you can use that as your discerning mechanism for these, the right activities. So if we don't know what that is, it's really challenging to know where we're going, right? It's that moving target. So what is a vision? Your vision statement is what you believe are the ideal conditions for your community or those you serve. If the issues are important to you as an organization, then how do we make sure that they're completely and perfectly addressed? It should be a short phase that conveys your organization's hopes for the future. So characteristics of a good vision statement are that it's understood and shared by members of your organization. Joel mentioned this, socialization, communication, communication, communication. Every single person that's part of your CV organization should know what your vision is or what their vision is, right? It's tied into, it's the vision across everybody. And some of the organizations, in fact, we do this at Medaxium. We oftentimes will start our meetings with a quick reminder of what our vision and mission are because it ties us back into the value of the work that we're doing. And it reminds us to keep that in mind, keep that at the forefront of the decisions that we're making. It needs to be broad enough to include diverse perspectives, inspiring and uplifting to everyone involved in the effort and easy to communicate. I'm gonna go back to the inspiring and uplifting. Inspiring and uplifting, a lot of us, mantras and words and those things, I will say in addition to that, they have to be actionable. So what I mean by that, if you've had a vision in place for a few years, but it doesn't feel like we've ever really hit that vision or the activities or the decisions we make aren't really in alignment with that vision, that creates an environment where the vision doesn't mean anything. So as you either put one together, as you're putting one together, you gotta make sure that it truly is what we're willing to measure ourself against and make decisions about. If you've had one, but we've not done a good job utilizing it as our true north, and we haven't been actionable around it, and when you kind of go back out and ask people what your vision, and do you feel like the organization values the vision and is in alignment with what you're trying to create, and the answer's no, then you've got some work to do. So that's vision. We go to the next one. We'll talk a little bit about, so advantages of a vision statement. A little bit I mentioned already, but creating a common objective for your teams. I mean, again, the goal here is that we're all tied back into that value and who we are and what we're creating for our community. We talk a lot about being patient-centric. Patient-centric is our community. So how do we, who are we, what's the value that we're seeking to create? Vision statement also can give hope for a better future. We're always seeking to do better, seeking to improve. Again, I would say if you had a vision statement and we've never really done a good job of aligning with it, you can also create a lack of trust around, well, we say things, but we don't really mean them. So you really have to make sure that we put our money where our mouth is and we need to mean it. I mentioned inspiring team members to realize their dreams through positive, effective action. That feels kind of big, but here's the reality. Delivering healthcare is really hard and it's been really hard, even recently over the last five years, especially with the pandemic. And I think when you feel tied in to that organizational vision and you feel, and you can see how your work ties into that, that creates an environment where it minimizes burnout, it minimizes disengagement. I think all of us are willing to work really hard. We're especially willing to work hard when we know what our work is contributing to and that's part of the role of that vision. And then finally, as I mentioned, providing a basis for developing other aspects of your action planning process. So mission, objectives, strategy, and action plans ultimately are all tied back into that vision. Go to the next slide. So mission, most vision statements come with a mission. So a mission statement describes what you are going to do and why you're going to do that. Mission statements are more concrete and action oriented than vision statements. And your mission statement will hint at the how. So again, we want it to be concise, one sentence. We want it to be outcome oriented, explain the fundamental outcomes you are working to achieve and we want it to be inclusive. So broad statements addressing key goals. You go to the next slide. So advantages of a mission statement are that the goal is to convert your vision into an action oriented terms. This is who we want to be. This is how we're going to get there. Explaining goals to interested parties in a clear and concise manner and enhancing your validity and professionalism in the market. Again, they kind of, they go hand in hand. All right, so we kind of started with that foundation. We got our people together. We know who we are. We know where we want to go. We know what we're going to measure our strategic plan against. I think the next important exercise for effective strategic planning is doing a current state assessment. And a very common framework for this is the SWOT analysis. But in essence, what a SWOT analysis is, is a program 360. We're looking at all aspects of our program, both internal and external. We're looking at what's going well, what's not going well, what are our positive attributes, what are our negative attributes and what are the things that are happening externally that are going to threaten us or give us opportunities. So when I think of strengths and weaknesses, we're really talking about who we are as an organization or as a program and internally what's going well. Maybe we've got great workforce. Maybe we've got good subspecialty talent. Maybe we've got lots of patients and we're locked into a strong market and with a lot of market share. Maybe we've got good leadership in place. Maybe we've managed our access really well. List out those things. This is a great time to come back and start to also celebrate some of the great work that you've already done. So what are those key attributes that we have going for us that we can lean into for to help manage some of the weaknesses? Now, the weaknesses are same things, but they're the things that aren't going so well. So maybe we don't have good access. If we want to grow our market, but we can't get our current patients in because we have poor access, we need to be aware of that. The weaknesses allow us to understand what are the things that are going to get in our way? What are the things we need to solve for before we can start to lay down a strategic plan? They also give us an idea of what roadblocks or barriers we're going to hit on the way. So I think understanding where our weak points are is also really important for, again, all your key stakeholders as you start to think about where do we need to be doing over the next one, three, and five years. Opportunities and threats are more external. So Joel actually did a great job of beginning to get you thinking by outlining what some of those external factors are that we need to be aware of and we need to consider what's happening in our market related to some of those larger healthcare initiatives and acquisitions and mergers and the way that our patients deliver care and digital medicine and virtual opportunities, different clinical programs and new guideline changes. Those are all things that we need to understand so that we can wrap those into what should we be thinking about strategically? What should our goals and action items be? And then the same thing with the threats. What's going to get us kind of that external threat for, again, maybe we've got new people coming into our market or new players coming into our market. Maybe we've got some major changes with some payer contracting coming up. Maybe we've got some bundle payments that are going to be laid onto our lap that we have to try to figure out how to manage. Again, it could be any number of things, but there are the things that, again, if we don't solve for it or at least be aware that it's coming, could sideline us or blindside us, if you will, as we begin to kind of work through where we want to go. So sitting down and really working through all of those things, that's also a great exercise for your strategic planning team. So all those people that you're bringing together either before the strategic planning event, work them through a SWOT analysis or as part of your strategic planning event, it's a good way to kind of get everybody thinking. I would also say the more that you as an administrator or leader of the program can bring in current state data. So I'll give you an example. We're in the process internally at MedAxium of we'll be doing a strategic planning session here in about a month. And right now I'm working to go through all of our objective data around our work and our revenue and the types of work we've been doing in our projects and some of those different things. So you want to start to bring in all your scorecards, your access measures, your quality measures, your cost measures, bringing all of that so that you're as part of that program 360 so that your strategic planning team is aware of all of those things as part of getting them ready to begin to understand or I guess empowering them to be able to help define the strategy for the future. So giving you again, just some ideas as you think about areas of assessment and opportunity identification for the average cardiovascular program, the things you need to be thinking about for sure accessibility. Can I get my current patients in? If I'm looking for areas of growth, what do I need to do to scale up my capacity, my demand, those sorts of things. Another area is your use of resources. So how am I related to room utilization or schedule utilization, or how am I using my facilities? Am I facility constrained or do I have room for growth? And you can do the same analysis on your staff, on your position workforce, on your APPs, on the rest of the teams that you have in place. Are we over, are we under? Just really understanding our current use and what we need for the future. Another framework, if you will, that you can use for this is kind of running it through the quadruple aim and those four different areas of objectives. How are we doing from a quality perspective? Pulling in all your quality data. How are we doing from a cost of care perspective? Are we managing into our value? Are managing both from a payer perspective and our overall utilization, but also from an internal perspective around the cost that it costs us to deliver the care? What's our margin, if you will? Patient experience, pulling in all your patient experience scores. I am a big fan. Your patients will tell you through those scores where your opportunities are. If they can't get in to see you in a timely, in their perspective of a timely fashion, which matters, they're gonna tell you in those scores. So bringing those in. And then finally, team. So staff engagement scores and ad hoc surveys and ad hoc interviews and rounding. What are you hearing from your team? What's the morale of your team? These are all great perspectives and areas of objective data to pull in as part of that assessment. And then additional other areas of consideration would be external frameworks. So many of you are doing US News and World Report reporting, if you will, or LeapFrog or others. I mean, those are kind of multifaceted external reviews. And you can look at the areas that they're looking at and internally measure yourself against those to kind of give you an idea of where you are, where your opportunities might be. And then finally, population and community needs. How well are we doing managing our current community incidence and prevalence? Looking at incidence and prevalence data, then comparing it to the number and the types of patients that are coming through our doors, is there a big mismatch? Are we not managing the needs of our community and the needs of our patient populations? If you start digging, you can get access to that information. And that can be very telling when it comes to where should we build out more programming, more accessibility, more capacity. You go to the next slide. So let's talk a little bit about goals versus strategies. And I'm actually gonna transition this back over to Joel to kind of talk about that. And then how do we all bring this home to an actual actionable strategic plan? Okay, so goals versus strategies. This is gonna get in the weeds here a little bit, but we often get kind of bogged down in these strategic planning areas. But we do wanna have some definitions in front of you. So when we talk, we're all on the same page. Goals are strategies, are the bigger kind of the overarching. And then the goals are, these are kind of the milestones along which we will achieve our strategy. So they need to be measurable and specific. They would have a certain time bound, time aspect to them. That's the milestone. Are we on the right path? Are we behind? Are we ahead? And these should be the milestones Are we behind? Are we ahead? And these should be things like increased market share by 10%. That's not the strategy. The strategy is something else. I'm gonna talk about that in a bit here, but how we measure whether we're achieving it, because it may be expanded to new markets. It may be bring in a new demographic or a new something. This is how we're gonna measure it. If Ginger brought up access, we would argue access is everything. It trumps all your marketing. It trumps all your strategy. If you're impossible to get into, no matter what you do, you're gonna struggle. If you're easy to get into, that makes a huge difference. So let's say we're gonna say, we're gonna get everybody within, in new patients within less than five business days. Very measurable. We can go into our scheduling modules, our EMRs, our practice management systems, and we can pull those data out, and we can put timestamps on it. Or we're gonna get our patient satisfaction up by the end of the year. Strategies are, they're the overarching. They're kind of the higher area of that. So they focus on the big picture. They have a broad scope. As I mentioned, examples would be things like, I'm gonna expand into new geographic markets. That is one of the big decision points for cardiovascular because CV travels. Our physicians go out into the communities and pull in care. It is often very difficult to determine where that should happen, how frequently, et cetera. That would be part of that overarching strategy. Delivering, expanding the way we deliver care. I talked about that a lot during my portion with all the kind of the mega influences on us that need to innovate and kind of push the envelope in terms of how we do things. The way we always did it, that tradition can get in our way. We need to kind of push the envelope. And that might be our strategy. We're gonna come up with new innovative ways that we could deliver care. And then back to the goals, how are we gonna measure that? Well, we're gonna measure it by the number of thousands of patients or our patient panel per physician. We should see that expand, right? If we're doing that care delivery better, we should be able to see more patients with the same resources that we did before. That might be an example of the goal on the other end. Becoming the employer of choice. That is typically something that would be measurable by external sources as well. Often our mission statements include something about our, you know, we're gonna be, we're gonna treat our employees like the most valuable asset we have. This is a way to put that into kind of the more practical practice. I'm gonna now kind of transition to the end. This is often overlooked, but is critically important. We need to both take the work that we have done throughout this strategic planning process and synthesize it. And that's not easy. And it, like I said, it often gets short changed. I couldn't find who to attribute this quote to originally. So I said lots of people, including myself. If we have everything as a priority, then nothing is. We need to figure out how we're gonna take a lot of different things we could do and prioritize them and focus them such that we can actually be successful in achieving them. Without disparaging anybody who's watching the webcast, we've often gone into organizations, we look at their strategic plan for prior years. I'm not kidding. In some instances, these were 75 pages of initiatives. Even in a large organization, that's gonna be impossible for anyone to follow. And what was often the case when we asked, people had either never seen it, they had never read it. They were certainly not following it. So we need to take our work and we need to really focus it and prioritize it so that we put together something meaningful and achievable. A nice, very simple prioritization matrix looks like the one on the screen right now. You have value on the vertical axis and effort on the horizontal. Ideally, we would have all very high value initiatives with very minimal effort. So they'd all be in that upper left-hand box. That's not the reality. Some things just take longer. And so taking our specific strategies that we've come up with and identified through our process and having your team then put these where they belong in this matrix, we may find out that some things go in the bottom right box where it's like, jeez, that's a lot of effort for little return. Maybe that's something we should reconsider or put off. So this helps you kind of synthesize that. Is this a perfect science? For sure not. However, with good team members, broad participation, as Ginger mentioned, you're getting a lot of minds working on this. I think the outcomes typically gets to where you need to be from that perspective of prioritizing. So how much will it cost? What will it take? Who should lead it? That's another very important aspect of this. We want to make sure we're assigning someone who's taking responsibility for driving that strategic initiative, being held accountable, maybe a little softer on that word because everything takes a team, but you need somebody who's gonna own it and drive it. And then we have to put a timeline on it and create those milestones that say, tell us whether we're in a good position on that one or not in such a good position. And often that needs to take the form of almost like a Gantt chart where certain things have to happen before we can go on to the next. And so identifying those and making sure that they're laid out in a coherent fashion and that they've considered all aspects of what that's going to take. And that goes back in some form to those resources. What is this gonna cost money? Do we have that money available to us? Is it gonna take manpower or human resources? Do we have those allocated and can they actually divert from their real job, so to speak, in order to pull this off? We need to think through all that on the other side. Otherwise, what we have is not a plan, but just a wish. So putting together these kind of final pieces, sign performance management, and then launch. So we're creating the team around each of those initiatives. We're creating the measurement tools. How are we going to identify whether we're on pace, we're on budget, we're on time, and that we're making a difference? Those are those milestones and key performance indicators or KPIs. And only then are we ready to launch. And the very first step in that launch is to socialize this with the entire team. I'm a broken record here saying again, but this is often a missed step as well. Our strategic plan stays at the very top. It doesn't get down to the entire team. So we would argue we just need to over-communicate the heck out of everything. It's communicate, communicate, and communicate. When you think you've said it enough, you're probably just starting to break through. So continue to do that over and over and over again. The larger the organization, the more perpetual that's just going to have to be. But it's so critically important that you communicate the heck out of this stuff. So in closing, what I would say is keep it simple. We want to have a well thought out strategic plan. It has to be robust, but it doesn't have to be overly complicated. In fact, I think that hurts your ability to pull it off. Make sure you're thinking big and thinking out far enough that you have the luxury of thinking big. Way too often, we want to think in like 12 months or maybe 36 months, three years out. But for those of us who have been around a long time, which I am one of, we realize how long it takes to pull off things. Three years is hardly, it's a blip. I mean, it's such a short amount of time. There's some science that suggests by looking out more like 10 years, we take away the prejudice of what we all have learned in our careers and we can think bigger and with fewer restrictions. So I would encourage you to do that. If it's onerous, if it's arduous, if it's dreaded by your team, something's wrong, we're doing it in an incorrect fashion, we should be able to make this fun and exciting. And then make sure you do those last pieces of prioritizing, assigning, measuring and holding yourself accountable. Nothing more demoralizing than a strategic plan that sits on a shelf and never gets utilized or executed. It makes people not want to participate the next round. So that is a critical piece as well. And with that, I am going to turn it over to the question and answer time and we'll look at what has come through on the Q&A panel. What does MedAxiom project for future virtual delivery of E&M compared to 29% projected from SG2? Well, great question, harder to answer. And before I get to that, I just wanna mention the reason Ginger isn't joining me in the Q&A is she had an important client meeting that she had to get to, so she had to jump off. So you have me for better or worse. I would answer that question in the following way. We as MedAxiom believe that in 2024, virtual care should be a permanent and intentional part of our E&M care delivery. It's something that is so valuable to our patients. It is able to extend our workforce. It takes fewer bricks and mortar resources, which are incredibly expensive. And it seems like we're always running out of space. This is a way to provide more care with the same amount. And like I said, a lot of patients, not every patients, but a lot of patients really respond well to that. Virtual care may look different from organization to organization. In some cases, you may be coming to me in my home because I have a setup like I have here, and I'm able to do that very competently and with all of the tools that a physician or provider would need in order to provide that E&M level care. For others, it may be where you're having them go to an office and it's the physician who is virtual or the provider, I should say, and you have some resources at that local area where you're providing the care. The point is this, it should be intentional and embedded in your daily activities. You know, what that percentage should be. A third is probably heavy for cardiology. If we can do 50% of our care virtually, you kind of have to wonder if we really need those touch points. But as we start to count like remote patient monitoring and some of the other services we can render, maybe it could get that high. I think for now, something in the order of 20 to 30% of our templates being virtually scheduled and supported makes sense for where we're at here in 2024. Hope this was valuable, and we'll make sure the slides are available through some means if you're not able to get to them now. But thank everybody for coming, and we'll give you back five minutes here for your day.

MedAxiom Strategic Planning

Joel Sauer

Ginger Biesbrock

vision statement

mission statement

SWOT analysis

strategic goals

virtual care delivery

healthcare innovation