Jesse Arnoldson and Jay Holmes, Principals at MedMan

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Saul Marquez:
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Saul Marquez:
All right, everyone, welcome back to the Outcomes Rocket podcast. Today, I have the privilege of hosting two great people. I’ll go ahead and introduce them to you. I’ve gotten to know them very well over the past few months. First, I have Jay Holmes. He has spent the majority of his career in public accounting with a lot of that working with small businesses and the health care industry. During a portion of that time, he served on Intuit’s accountant counsel helping lead innovation in the small business accounting arena. His public accounting days are happily behind him, and he spends his time now as the visionary and Chief Financial Officer of MedMan helping medical practices thrive.

Saul Marquez:
I also have a Jesse Arnoldson with us. Jessee has spent the first three years of his career traveling the Northwest as an interim administrator for MedMan working with practice experience, enormous amounts of change, and challenge. Since that he’s grown roots as the administrator for the pediatric group in Boise, Idaho. Jay and Jesse are two of the four principals at MedMan, and if the name MedMan sounds familiar to you, that’s because 343, we had one of their partners, Randy Álvaro, chat about improving clinical operations, which is at the core of what they do. So I’m really excited to have both of these gentlemen on the podcast. And so without further ado, welcome, Jay and Jesse.

Jesse Arnoldson:
Thanks, Saul.

Jay Holmes:
Saul thanks. Glad to be here.

Saul Marquez:
Absolutely. Now, folks, we really want to take advantage of this opportunity to learn more about them. What’s coming is some brand new stuff that they have working on. A podcast that you’re going to want to learn about, but also the amazing things that they’re doing at MedMan. So before we jump into those juicy things, I want to open it up to both of you to tell us a little bit more about what inspires you in health care.

Jesse Arnoldson:
Yeah, I can jump in here. Honestly, Saul, I was never going to be a physician. Although I totally get behind the mission of what doctors do, the things under the skin just terrify me. And I wasn’t going to be able to hack it. But I soon learned through school and getting into the real world that there was a place for me to play a part in the health care delivery system. And getting into MedMan and seeing the history of the hundreds of clinics that we’ve worked with. There’s a significant difference between a practice that is running incredibly well and one that isn’t, and the quality of care that that practice then produces. A physician who is engaged in the right way and sleeps at night knowing he or she is going to make payroll the next day for their staff, that physician’s mind can be more focused on the patient at hand in front of them. The one who’s stressed out and is worried about every little thing going on in the practice that’s going wrong, that can have some detrimental factors in the care that he or she delivers. And so, you know what? What gets me up in the morning is more than enough to keep me engaged and fulfilled in my career is getting behind a good physician and doing the things necessary to help them completely focus on delivering good health care. So if the tools, the ideas, the leadership, whatever it is, they need to be their better self, their better physician self. That’s what I can do, is stand behind them and empower them to do that.

Saul Marquez:
That’s a great reason to be in it. And I could totally tell you, love what you do. How about you?

Jay Holmes:
So where I came from is, what attracts me to the health care space is the complexity in it. We live in a world where there’s so much waste in health care and there are such an opportunity and so much strategy that we can apply to it to really gain in so many areas. And my background is really on the business side and strategy. And, you know, you get into the health care world, and all of a sudden that strategy in the complexity just increases because of the regulation and revenue cycle and just the different components. And so what really draws me is it’s a harder puzzle to crack and, you know, it’s really never-ending. And there’s all change going on every day. And with the change, there are opportunities. And so that’s really what draws me into the health care field.

Saul Marquez:
I love it. And, you know, we’ve gotten to know each other here over the last few months. And I just love what you guys are doing at MedMan, but the listeners may not know as well. So let’s park there for a second and talk to us a little bit about how you and MedMan are adding value to the health care ecosystem.

Jay Holmes:
Absolutely. Well, MedMan at the heart. We’re a practice management company and we do quite a bit of other things as far as MSO type services, back-office type things, but really what we’re after is we’re after helping independent providers practice medicine and our vision is inspiring organizations and we do that through creating incredible clinics. And so our role is to create the machine that providers can work in to deliver awesome, incredible care. And so were the component to say, how can we create the processes and get the right team together to ultimately give that provider the platform that they can then deliver the care.

Saul Marquez:
Yeah, that’s fantastic. And it’s hard, right? Because physicians go to school, they study medicine, and it’s totally different than the business of medicine. It’s challenging. And there’s the coding. And I mean, it’s just terrible to try to manage everything. And as I see you laughing there. But it’s true right. And so talk to us about what you believe makes you guys different than the other things that are available out there today.

Jesse Arnoldson:
Yeah. You know, I think if you if you picked our website or our service menu apart, you could probably find a different company that lines up with a lot of them. And so, you know what makes us different are three main things. One is that MedMan has been around since 1977. We were the first practice management company ever in the United States. And that, while may sound like we’re just trying to grab back bragging rights, it means that we have experience with hundreds of clinics. We’ve seen how it’s done in almost every scenario and that historical knowledge and experience, we’re able to turn that around and benefit the clinics that participate with us and give them let them build on that institutional knowledge. The second thing is that, as Jay said earlier, we’re focused on the independent physician. We believe that an independent physician who’s engaged, whose practice is running well, can probably deliver what we would say is a higher standard of care than most. And so I think a lot of organizations are focused on the merger and acquisition or the hospital run clinic because there’s a lot of money in that. But we think that there’s better quality care from an independent physician’s office that’s running well. And lastly, our focus on our sharing value and this is probably the thing that makes us the most unique in that we’re very aggressive on sharing best practices, best ideas across our network. And so if somebody has a skill or an idea or a best practice, that gets shared across all of our clinics and we all improve because of that. We collaborate, we share, we build upon each other’s best ideas and get the most out of a network of administrators, all with different experiences and history to where I stake my career on it. We have the best practices out there and it benefits the physicians and therefore it benefits the patients that come and see them.

Saul Marquez:
That’s really well said, Jesse. And, you know, I think you guys have found a way to systematize crowdsourcing of this knowledge. This base of this has worked. This hasn’t worked. Let’s learn. And I can imagine that even during times, crazy times like now, where time-sensitive learnings could be greatly scaled to right? I mean, have you seen anything like that be a benefit?

Jesse Arnoldson:
Absolutely. You know, during the crazy times of March and April of this year, it was easy to find friends to talk to almost each and every day and sit down and talking about the PPE. And we were talking about safety precautions that we should be taking and bouncing things off of each other. And it was an enormous help to not have to do that alone. We all belong to associations and our associations are strong and great. But you don’t get as much of a shoulder to shoulder peer experience as you do in our organization. And so, yeah, absolutely. I think all of our clinics are better off for having had us working through this together rather than trying to lone-wolf it.

Saul Marquez:
I love that. And so let’s talk about outcomes and business innovation. How do you guys improve that?

Jay Holmes:
You know, kind of our approach is, isn’t this is what a clinic has to fit into work and kind of talking about back to the unique of MedMan in the sense that we’re here to improve and increase the independent practices out there. And so we take an approach that takes our best practices and our processes and then really meld it together with the uniqueness of a provider and the culture that they want to have and then try to create the best of both of those. And that’s really what we see, the friction that’s being created in the employment world, where we have providers that are being told how to provide care when to work, how to work, and all that. And it goes against a lot of who they are and how it ultimately them feeling like a real person rather than just a number and getting treated like what we can just replace you provided with the butter and everything will move on. But health care is such a person to person industry and experience and that matters so much. And so the environment in which your practice matters so much too. And so really the way that the way I see that we really improve outcomes is that we create that environment where the providers thrive. And that makes such a difference. You think about the chain restaurant that, you know, no matter what, everything’s coming out the same way because it’s all it’s either frozen or here’s your twenty-two step process to get the fries out in three minutes or two and a half minutes or whatever, versus a sit down more of a person. Here’s the chef. Guy’s going to come out and come out and talk to you. And while they’re both ways of means to an end, we find that having that uniqueness and having the flexibility to create a space to really have certain providers thrive in it really makes a difference. And so it’s not to say that one’s better than the others, but there are certain providers that work better in different systems, in different areas. And that’s how we’ve found a niche and feel pretty good about enabling those providers to do that.

Saul Marquez:
That’s really interesting, Jay. So give me an example of the environment and maybe a story of how it’s resonated.

Jay Holmes:
Absolutely. This is something Jesse can take on. We just helped two pediatricians start a Thrive pediatrics here in Meridian, and they came from an employed environment and said, hey, this is how we want to practice medicine and these are the people we want around us. And we’re OK spending a little bit more for having really amazing people and we’re OK to spend a little bit more having a culture that is as abundant and thriving as possible. And Jesse, take it away. I mean, you’ve led the charge there. It’s been a year, a little over a year. And it’s an amazing clinic and they’re making more money than they were before. They’re working less and all around. You know, there are just so many things that that are going well because of that.

Jesse Arnoldson:
Right, it really was a matter of them. You know, they didn’t work in a toxic environment by any means, but they wanted to do things a little bit different and to have a little bit, you know, a lot more input into how decisions were made and the culture that was put in place. And so to have a couple of physicians engaged in that way was just fantastic. You know, you mentioned in my bio that I was doing interim assignments before that and most of my interim assignments were coming into clinics that had been established for several years, if not decades. But we’re going through some really hard times and it was hard to turn things around, you know, even in a short amount of time. It was so much fun to start from scratch and to have a couple of physicians that were ready to try new things and to get out there and really, you know, put their money where their mouth was when it came to creating a culture and finding the right people, getting them in the right seats. Even just today, we brought in half the staff to do personality training to help us understand how our personalities mesh better and fit better together and how to communicate and how to have good conflict and how to grow as individuals.

Jesse Arnoldson:
And we’ll do you know, we’ll take care of the other half of the clinic next week. But that’s the kind of physician that we really want to get behind. Somebody who wants to be engaged and wants those higher-level things. They then partner with us to do that. You know, that’s not all. It’s not all us. It’s a two-way street. And the recipe requires engaged, like-minded physicians that they can get on board with this kind of thing and help drive it. Our best clinics are not those that come to us and say, I want nothing to do with the business. I only want to go into the exam room and come right back out again. Those are the ones that we best engage with. It’s the ones that say, look, I want to be in the mix of it, but in the right way, on the right things, making good decisions. And I need your help to do that. And that’s where we’ve seen, you know, practices like this one just thrive and really stand out.

Jay Holmes:
Yeah, one of the first things we did on the journey of opening this clinic and really building out space pretty much from scratch has a planning session around values and vision and in that sort of thing, which set the tone because understanding that if we lay the foundation and lay the groundwork and we all can get behind it, the team that we get is going to be that much stronger in that much more quality, and then, you know, as we know, 80 percent of all problems are people problems. And that’s one of the hardest things that we face as we go into a new clinic. New to us is that 80 percent of problems are people problems. And you as an owner generally have a pretty decent bias built up about your people. And you can’t really see how certain people are bringing down the rest and going into it and saying, hey, if we can, we can measure everyone or stack everyone up against your values. That’s a really good measurement to help create some clarity about who fits and who doesn’t. And you take a bad apple out of the mix. And all of a sudden, you know, there’s just its amazing progress. And it’s hard to make that call in the short term because all you’re thinking about is it’s going to add so much more work. I’m on the train. But starting from that values conversation beginning really allowed us in this case to push forward really quickly. And here we are a year and hired another provider. They’re trying to hire another one in the middle of a pandemic. So, yeah, all around. Yeah. And working well. And it’s awesome.

Jesse Arnoldson:
It doesn’t mean that we don’t deal with issues. We deal with issues left and right, but we do so in a respectful way with everybody on the same page using our values and our mission to kind of guide those decisions. We take care of important stuff in a timely manner and we so we enjoy it. We the issues that do come up, we handle and we take care of it, but we enjoy it and we enjoy each other. So it’s not a world where no problems exist, but we take care of it.

Saul Marquez:
That’s fantastic. Yeah. And a great example, guys. Thank you. It’s hard. And I love the very simple idea that 80 percent of the problems are people problems. And if you’re listening to this right now, you’re thinking about your business, your practice. Think about that. If 80 percent of the problems are people problems, how are you addressing them? And oftentimes we tend to be very close to those people. So do we have blinders on? And is it better to have pros like the MedMan pros come in and help you see maybe what you’re not seeing?

Jesse Arnoldson:
And sometimes all you’re one of those people that’s causing problems.

Saul Marquez:
That’s on point. And if you care enough about your business, you will get out of your own way and work with a group like MedMan to get your practice to the next level. So a fantastic story. And so speaking of problems, what would you say is one of the biggest setbacks you guys have experienced, and what was a key learning that came out of it?

Jesse Arnoldson:
You know, as we purchased the company from its original founder and took over, the same problem that plagued old MedMan has been a setback for us, as well as how do we scale how do we manage all these things? We have such a tight involved relationship with almost every single one of these clinics. It’s hard to scale that across geography and across multiple specialties. And it’s been tricky to get what we know to be best practice, to be common practice, because we can only touch so many lives at once. And so we, you know, Jay, myself, our partners, our employees, we run ourselves ragged trying to push the good word out as much as we can, but only got so far because we hadn’t created a product that scaled. So it put us in at a point. It’s continued to put us in mountains and valleys of burnout and stress and trying to figure it all out. And that, you know, that kind of leads us to where Jay will take us in where MedMan is going. But that’s probably been our greatest setback so far, is not knowing how to scale and then just working ourselves ragged to keep up.

Saul Marquez:
And I think a lot of us have that challenge, right. And great things come from figuring out that, you know, having that epiphany or maybe the slow learnings through time to get you there. So talk to us about the key learning.

Jay Holmes:
So the takeaway here is that there needed to be a shift in the business model that if we’re relying on boots on the ground as our main conduit for change, then we need a lot of boots on the ground that is really experienced and really knowledgeable. And we realize that that’s challenging in a lot of ways, and especially as we’ve grown from the Northwest and we’re pretty diverse as far as clinics go across a lot of rural clinics. And it’s not that there are one hundred clinics and a ten-mile radius as other parts of the country. And so it took a lot of resources to spread that. So the business model needed to change. And really through that, we’ve learned that that’s the big learning. The big takeaway is that how then can we shift? How we engage in how we pass along to more administrators, more practice managers, best practices, and really the connecting like we’ve been able to connect with our employed administrators, how can we create more cohesion, more sharing of information and in a bigger and more scalable way? And, you know, last year through our annual planning session, our 10-year target that came from that is every clinic in the country has been inspired by a MedMan way.

Jay Holmes:
And really what we’re trying to do here is to say how can we act? And so that in 10 years from now that we’ve added, sparked, engaged, furthered every single clinic that that’s in our country. And that’s really what we’re after. And so what does that look like? Well, it looks like us taking our institutional knowledge of forty-three years and hundreds and hundreds of years of practice management experience with all our employees and staff into more digital, more online, easier to access and digest information. And so that’s really the journey. The current journey we’re on is tweaking that, changing that, and beginning to deliver more in a digital way that’s easily accessible, which takes us to a pretty exciting thing, which is our podcast that Saul you’ve been helping us with smooth podcasting your side gig and just has allowed us to have a platform to do just this, which is share amazing practice management stories, ideas, and really allow us to further that 10-year target.

Saul Marquez:
That’s that’s fantastic. And, you know, by the way, the MedMan podcast is pretty awesome, some of the learnings and why you guys are doing it. And listeners, totally recommend the podcast. You’ll see it in the show notes. You could also see it at MedMan.com. But I was thinking about what you were saying and sort of how you started this evolution, right. like you’re taking this business that’s been boots on the ground and you’re working to digitize it. I remember being at a business conference and I was having a discussion with a couple of people, business owners. And then we sat through this panel interview. It was like the CEO of Soul Cycle. It was the CEO of Airbnb and the CEO of Warby Parker. And the CEO of Airbnb talked about that one day in San Francisco, they had those air mattresses and they worked out and then they tried it again and it failed. And they had to figure out a way to go from brick and mortar to how do we scale this thing, right. And it’s exciting to think about what you guys are doing to scale what you already know how to do so well. And so I’m jazzed about the vision. And you guys have obviously shared it with me, but now we’re kind of giving the listeners a sneak peek. And if you want to learn more about what the MedMan guys are up to, the podcast is one way to learn about it, because they’re there slowly dripping out their ideas on that. And I think you’ll find a lot of good things from it. So what are you guys most excited about today?

Jay Holmes:
It’s just that. It’s this idea that continuing education as we know it, this learning doesn’t do a whole lot. You know it’s geared to gain information, but it doesn’t really get you to a point where you can have an impactful change, doesn’t get give you a step-by-step guide. And it doesn’t really say, hey, if you do this, you’re going to improve this or this or this. And it’s just there’s so much noise in general, how we learn it from an operation standpoint. And that’s really where our roots are from, which is the operations. We know the boots on the ground. We can come in and we can help things. But that’s the exciting thing. Is that working out now, which is interesting, Saul, just to back up a little bit, it was in 2000, we actually got rid of our brick and mortar home office and we’re remote back when it wasn’t cool. And it just so happens to be out of necessity now. But it was a fad for a little bit. But yeah, so but what we didn’t do is we didn’t take the next step, which is how can we then transfer this knowledge in the same medium? And so that’s what I’m really excited about, is how do we shift this learning experience to more of how can we get you in an operation, in a clinic to make advancements without reading a hundred books or spending thousands of thousands of dollars? How can we improve all those clinics out there?

Saul Marquez:
And you think about the legacy right.. 1977. You guys were the first medical practice management. Why not be the first to do this at scale digitally. And that right there is inspiring. Fantastic, just incredible work. It’s been a lot of fun working with you guys to get the podcast off the ground. You know, you guys have pushed us, too to get better. And I love the level of detail and the professionalism that you guys do everything with. It’s been so much. Fun working with you guys on this and so listeners. Take a listen. If you’re wanting to learn more about operations, I think a lot of the stuff that they talk about in their podcast, too, is applicable to even regular businesses. So but definitely practice management, health care, office management, these are the things that they’re honing in on right now. Before we conclude guys, I just want to say super, super proud of you guys and excited for the work that you’ve done. But give us a closing thought and let us know where we could learn more about what you’re doing.

Jesse Arnoldson:
I think the main thing that if we could leave only one message, if nothing else, is that the way that medicine is delivered and managed can be so much better, you know, and we can together inspire one another to do that. And it requires us to share what we know and not hoard that, not hoard, you know, the few good things that we know how to do. And this side holds that what they know how to do, but aggressively sharing that information and pushing one another to become better. I mean, that’s the whole way that MedMan is working towards creating these incredible clinics. That’s how we’re going to inspire organizations to become better. And again, we’re just so excited to try and do it in a way that touches more lives, more clinics, more patients than what our small footprint has been up until this point.

Jay Holmes:
Yeah, and to double down on that whole sharing thing. You know, sharing is one of our core values. Thinking back when I was in the 70s, 60s, maybe, but this Boston, Massachusetts, just area of tech and tech growth and in how Silicon Valley took over that in speed and breadth is really because of the sharing aspect. California had a lot looser of non-competes and other restrictions on sharing information. And because of that, Silicon Valley is what it is today is because one employee could jump ship and go to another and really infect that new company with all this stuff it learned in. Are all the companies better off for that? Absolutely. And we have this mentality of, well, no, that’s my intellectual capital. I can’t share that because that’s so much better for the company. But at the end of the day, it’s really not. And so we have to get out of that mindset and really say the more we share, the better all of our lives will be. And, you know, and that’s what we believe in and that’s what we hold up day in and day out. And really, we have six core values. Another one is intellectual curiosity. And that’s really pushing a lot of this is to say we don’t settle and no matter what happens in the day, we always think, well, is there another way to do this or is there a better way or is there something that I just heard that I want to know more about? Because how can I apply that to this situation to that? So those two values really, really are driving the excitement of tomorrow for MedMan.

Saul Marquez:
That’s outstanding. And so if the people listening today want to learn more about you, where do they go?

Jesse Arnoldson:
MedMan.com is where we have our MedMan podcast, our blog, all of our services. Our teams on there. You can contact us,

Jay Holmes:
Go there and shoot us an email. We’re both first names at that MedMan.com so I’d love to hear from anyone comments, questions, anything like that.

Saul Marquez:
Outstanding guys. Well, listeners take them up on their offer to connect. Visit their website, MedMan.com, or reach out to them via email. We’ll leave all of those links in the show notes so that you know where and how to get in touch with them. Jay Jessee, huge kudos to you guys. Congrats on the podcast. Congrats on this evolution of the business. I’m really excited to see where this goes. I think it’s going to be something very promising for all of us.

Jesse Arnoldson:
Thank you, Saul.

Jay Holmes:
Thank you, Saul.

Saul Marquez:
Hey Outcomes Rocket listeners, Saul Marquez here. I get what a phenomenal asset a podcast could be for your business and also how frustrating it is to navigate editing and production, monetization, and achieving the ROI you’re looking for. Technical busywork shouldn’t stop you from getting your genius into the world, though. You should be able to build your brand easily with the professional podcast that gets attention. A patched-up podcast could ruin your business. Let us do the technical busy work behind the scenes while you share your genius on the mic and take the industry stage. Visit smoothpodcasting.com to learn more. That’s smoothpodcasting.com to learn more.

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