Thriving on Thin Margins: Building Sustainable ABA Practices on Medicaid

Simone 00:00:01 Welcome to the Flychain Reaction, a podcast designed to empower healthcare providers like you to master the business side of running a practice. Each episode sparks a chain reaction where actionable insights on financial management, operational efficiency, and growth strategies build upon each other, creating a powerful ripple effect to help your organization thrive. With Flychain's financial expertise and insights from industry leaders, we'll dive into everything you need to ignite success. Join us and let the flychain reaction spark growth in your healthcare business.

Ethan 00:00:41 Hi, and welcome to another episode of the Flychain Reaction. I am Ethan, one of the co-founders here at Flychain. And we're really excited about the topic we're going to chat through today, which is really thriving on thin margins and building strong, sustainable ABA practices, kind of with a focus on Medicaid and running a Medicaid business, which I think inherently has some thinner margins, perhaps different challenges than running a business where it's largely maybe a commercial-based insurance practice.

Ethan 00:01:17 And so, I think for us, we really see, from the Flychain lens, among our customers, Medicaid is really the lifeblood of I think many ABA therapy practices. But thriving when maybe the lion's share of all of your revenue is derived from Medicaid, it just makes running a business a little bit more difficult because obviously you have lower margins, which means less cash and profitability to run that business. And so one of the things that I think we're going to focus a lot on today is how disciplined operations, smart financial insights and actually like a people first culture can really help weather these storms. And we'll get into that. But in this episode, we're joined by Charlene Kurth, the Chief Operating Officer of Office Puzzle. Welcome. Thank you so much for joining.

Charlene 00:02:14 Thank you. Happy to be here. Excited.

Ethan 00:02:17 Yeah, yeah, this will be fun. And really, we just want to spend some time together to explore, really, what it takes for ABA practices to build that sustainable business culture. They're all related. We're generally working with very mission-driven businesses in this Medicaid landscape. And we're going to talk about that intersection of operational discipline, finance and strategy, and culture and how all of those things can work together and create a balance between that part and business. Our customers have the biggest parts to extend that footprint of care. It often does rely also on good ops, good financial insights, better decision making.

Ethan 00:02:59 So with that, I think we wanted to just to kind of jump in a little bit. Again, Medicaid is one of the biggest sources of funding in this space. And we see like reimbursement rates in Medicaid generally being lower. You know, that's not always the case depending on your state. Like some states, you could literally be 15 minutes across the state line and have very different Medicaid rates. But overall, we see them to be a little bit lower. And again, that's going to pose some margin challenges, especially when I think ABA generally also has just, I think, more thinner margins and we've got like, you know, salary and rate compression going in opposite directions that further contribute to those sorts of negative margins.

Ethan 00:03:47 And so, before we jump into some meat here, Charlene, we'd really just to like, love to get to know you a little bit more. You've got an amazing background. Maybe talk us a little about yourself and, you know, where you started, what got you here, what makes you tick and I think that'd be great to provide some context on who Charlene is.

Charlene 00:04:09 Yeah, happy to do that. I would love to say that there was some big strategy in mind that got me to where I am today, but it was a lot of right place, right time, taking advantage of opportunities presented to me. Early in my education, I knew I wanted to help people, so I did study Psychology, have a degree. And I very quickly realized that I was better suited to maybe build the structure and support the people who were doing that work. I think I'm a little too empathetic and would bring all of that home with me. But I ended up going in a completely different direction, really leaned on the structure and data analytical side of my brain.

Charlene 00:04:45 And by complete chance ended up in a practice management software for the mental health providers. And a light bulb went off. It was that moment where I realized I love structure. I love technology. There's a whole world of technology that helps people be organized and efficient and run operations in spaces that I feel really passionate about. So I like to say now that I work for companies that help people who help people. And through that, I can amplify my reach of what I, maybe deep in my heart, wish I could do.

Ethan 00:05:17 Yeah, I love that. We say the same thing. Unfortunately, you know, fortunately or unfortunately, don't have that bone in our body to deliver care necessarily, but it's the helping the people from our lens that are actually helping people expand their footprint, make them more resilient. I think rising tides raise all ships in this universe. And you know, excited to chat with you here because I think we've got that same ethos and mission to support our shared customers. Yeah, yeah. Just maybe going a little bit into just the Medicaid reality, right? We're not going to get too in the weeds in Medicaid because it is different in every state, but we're kind of talking in generalities here about Medicaid.

Ethan 00:06:01 And I think, you know, it's essential, but challenging for a business specifically if they're either strictly Medicaid or predominantly Medicaid. You know, we see a lot of ABA practices, they rely on Medicaid and it's actually sometimes a lot more complex from a billing and operational standpoint. Charlene, maybe if you could chat a little bit about from your lens, some of the pressures maybe that you've seen, whether it was in your prior practice management role or today here at Office Puzzle, how have you seen some of those Medicaid businesses? How those challenges manifest and maybe some things that you've seen folks do best practices to maybe prepare or get them through perhaps cashflow issues due to lags or candidly in some cases just that lower reimbursement which makes it more difficult to run a sustainable business?

Charlene 00:06:55 Yeah, absolutely. I think about it in a couple different ways. I think the first thing is... you mentioned at the very beginning that often people are going into these fields from a very mission-driven perspective and Medicaid allows you to reach communities that might not otherwise have access to this care. So it creates accessibility but with it comes immense compliance requirements, potential for error in how you apply it. And where I've seen practices be most successful is when they're not focused on managing Medicaid and waiting until the billing to make sure that everything's done right. They're actually designing entire systems around the Medicaid requirements.

Charlene 00:07:37 And so when you start from the very beginning, you think about patient intake, client intake, to scheduling your documentation's data collection and think about how that all connects and what those requirements are, making sure you're designing your systems right, you can start to avoid some of the issues that create that lag that we're talking about, the denials of claims that come further down the pipeline.

Ethan 00:07:58 Awesome. Yeah, there's definitely like, I think a big emotional component to serving that Medicaid population. It is a vulnerable population if you want to call them that. I think it's really important to... love to share your thoughts on just that culture of empathy. We're going to talk more about that down the line. But yeah, maybe have you experienced any of those businesses working with those businesses that you can tell that they're in it for all of the right reasons, but might not necessarily have the business acumen or financial acumen to really navigate some of those challenges? I don't know if you've seen any--

Charlene 00:08:36 I do. I do. I've got like a decade of time spent with people uncomfortable with the idea of like mission and margin and the fact that they really, they have to coexist. I think when you go into a field like this, you're maybe not starting out for that business side. You're also not being trained or educated on what it takes to run a business. And then on top of that, you get a little bit of that discomfort of if I'm here for the mission, I'm here for my clients, can I also be thinking about the financial success of my business. And I really am a strong advocate that those things are not at opposite ends and they have to work together. If you are not running a profitable business, you are no longer sustainable. You cannot serve the people that you want to serve.

Charlene 00:09:25 So, it's funny because I also see that parallel not only in the clinicians who are providing care, but when you work -- I don't know what your experience is. But when you work in a field like a company that's supporting those people, even your own teammates sometimes have a hard time combining this idea of financials and mission work, mission driven work. So I really like to remove the discomfort around it and just talk very directly that being successful as a business and making money helps you to sustain not just financially and like run your business, but you personally. You need to eat, you need to be able to have a life and be able to serve your clients without burning out.

Ethan 00:10:04 Yeah, I love that notion just to double click on. They're not like mutually exclusive in terms of being able to run like a financially stable, healthy business and also, deliver care to vulnerable populations. One thing that we've seen, and this isn't going to be the same for everybody. But, you know, folks with those big hearts that are serving the Medicaid population, what we'll often see is they'll also then work with some commercial pairs as well, where the margins might be a bit higher. And it gives them almost like subsidizing the Medicaid portion of their business because they know they might even be breaking even on the Medicaid population, but it's the margin from serving with some of those commercial pairs as well.

Ethan 00:10:46 So we've seen that be a strategy that has actually worked quite well with a number of our customers. Or they start off on the commercial side and have a, perhaps, better margin profile there. And then gives them the ability to then go and serve. So, you can start on either side, but then we'll see a nice blend to help kind of both make some money, but also, deliver care to that population. Just a little tip that we do see that diversification of payers, diversification of revenue sources is something that also will just inherently make your business a little bit more resilient.

Charlene 00:11:25 Yeah. And not to mention, not to get too corny with things, but you know, that you can't fill a pour from an empty cup. So it's not even just the financial viability of your practice. But if you're completely burned out and you're trying to make ends meet, you're stressing about how you can pay your staff. Do you have to lay people off? Can you even take on more clients? You're not even delivering probably the best care that you can. So it's financial success as well as delivering better client care.

Ethan 00:11:52 Yeah, they're all related. They're all -- might not seem related, but they very much are. It's hard to keep caring for people when you might not have money to cover bigger \[inaudible\].

Charlene 00:12:02 Definitely.

Ethan 00:12:03 Yeah. So just to actually double-click a little bit more into maybe get a little bit more tactical, perhaps. So from your perspective, are there any key elements that you've seen work successfully, especially given that sort of practice management view that you bring, that perspective that you bring us. Maybe if you could talk a little bit more about some of those like best practices, whether that's like structure, some elements about structure in the organization. Because you're very much in that, we'd love to just like learn a little bit more about what's the most important, what might be the most challenging, what are the low hanging fruit to fix. You know, talk to a little bit more about that. I think our audience is always looking for more operational efficiencies. And what is the most important things that they need to be doing to make sure they don't screw up?

Charlene 00:12:58 Yeah. So I have a unique perspective on this and not what you're probably going to expect from someone who's working at a software company. If you're asking me the most important thing, the most important thing is having a strong company culture. And we'll get to that in a little bit. But, you know, technology is not a silver bullet. So you can purchase whatever software you want and people aren't using it, they don't understand why, they're not actively working towards what you're trying to accomplish as a company in your mission, no technology is going to work.

Charlene 00:13:30 So we'll put a pin in that, but that's the most important thing. But beyond that, I think about not fighting against yourself. So, finding ways to solve the little problems that add up. Sometimes your focus is distracted on the bigger issues and you're losing focus on the small things that make a difference. How is your scheduling set up? Are you being the most efficient that you can? Are you looking into cancellation reasons and ensuring that utilization is where it needs to be? Are you ensuring or putting process in place to ensure compliance on documentation so that when you get to the point of submitting claims, things aren't being denied?

Charlene 00:14:16 And of course, all of that can be done with technology. There are tools purpose-built for that workflow. The other thing I would recommend, and I think the practice is doing it best, is when they take that data-driven approach that they use on the clinical side, and they think about their business in the same way. You're all data analysts. You're constantly thinking about how the data influences behavior, think about that on the business side. Take a step back and analyze the results of your business, whether that's financial results, whether it's operational results, and start to pinpoint where you need to pay attention.

Charlene 00:14:50 So not super tactical because I think it really is dependent on each practice to figure out where you need to diagnose and spend that time. But if I were to say like the steps to put in place, make sure that you've got the technology or the systems in place to support what you're trying to accomplish. There are things built for this. You don't need to reinvent the wheel. Make sure that you've got a strong team in place that they understand what you're trying to accomplish, and they feel really motivated and dedicated to making those systems work. And then don't be afraid to use what you've been trained to do to figure out how you need to improve your operations of the company.

Ethan 00:15:31 Yeah. Some things that I heard in there that I could not agree more with is it's paying attention to the little things that can make a difference. And it's like, yeah, one little improvement here might not move the needle tremendously. But when you can find those five or six little improvements, then all of a sudden, you can really elevate your business and streamline processes. We see that. And you hit the nail on the head. We don't have to do this all ourselves these days. I think flashback 10 years, the systems in place, the tech that business, the industry was much more nascent than too.

Ethan 00:16:06 I think we now see so many cool companies that are building like purpose-built point solutions to ensure that those little things, those little cracks in the sidewalk gets cemented over and you're really good. The other thing too, and I think this relates to not just the systems, but the people, and it's like setting up processes and the folks that leadership to set up the processes in place kind of gives you then the foundation for scalability. What I mean by that is, you know, having everyone on the same page, being transparent within that, not just the leadership, but you know, whatever mid-level clinicians, whatever you want to call it, I think having transparency so people know what their specific jobs are, but how it relates to that overall journey of patience, onboarding, ultimately, then getting paid by insurance, which is what we're all trying to get done here, which is not always the easiest.

Charlene 00:17:07 The point you're making... a couple of things you brought up when you talked about scale. When we talk about the small things or things that are seemingly small, but can drive efficiency, that is even more important the more you grow. So as you add additional staff, as you service more clients, these small little issues become huge mountains that you have to overcome. And so having the systems in place but also finding those inefficiencies earlier on help you to ensure that you can grow more effectively.

Ethan 00:17:38 Yeah. And just also going back to like structure and process and your experience, and it might be... there isn't one single thing. But we've talked before around clean intake, authorizations, documentation, EVV, billing workflows. In your experience, maybe each one of those can actually cause this to break. But from what you've seen, are there any one or two that really stick out to you that has been, oh, they didn't do this right. And if they had fixed that problem, they wouldn't be in a really rough spot. I have some ideas, but we'd love to... you know, we're not a practice management software.

Charlene 00:18:16 Yeah. I think from my experience, just to speak from Office Puzzle, the way things are done, we really try and build a lot of what would cause that to happen into the workflows themselves. So helping to drive some of those efficiencies and compliance to avoid. You didn't put the right code on this form, or you missed a step, or you didn't fill out the form in the first place. That is all built into how the workflow is generated. I haven't seen that in the sense of missed steps that then cause inefficiency on the workflow side. I think sometimes it's the things that people are not necessarily paying attention to as much.

Charlene 00:19:02 I do think the scheduling component can take up a lot of time. And it's that maybe that secret killer of efficiency. I think a lot of people focus on billing because they're thinking about the end of the process, like the billing components, where you then get the money. That's super important. So, you're always going to focus on that. But you forget that if everything is broken before you get to that step, you're making things so much harder for you. So I wouldn't say I'm, you know, from my perspective, what I've seen, I can't pinpoint it's this one thing. But I would say, make sure that you're not only focused on the very end of the workflow and that you're thinking about all the steps that are required before that to ensure that the very end is smooth.

Ethan 00:19:45 It's crazy. I could not agree more. We see people focus so much on billing, which again is in many ways the lifeblood of your business. It's how you get paid and how you make payroll and perhaps grow. But I can't tell you how many times we've worked with customers that have made like a little misstep. Sometimes it's their fault. Sometimes it's not their fault at all. And maybe it's like the payer didn't \[inaudible\], they went through the appropriate process, but the payer didn't recognize that that employee can actually serve even though you've done all the right steps.

Ethan 00:20:18 And then now we have, it gets rejected and we have to rebuild. So, you're right. It does. It all starts when you have that first patient kind of engagement and running them through a streamlined process that checks every single box so that you can then ultimately get paid. I love that. I think we've spent a little bit of time now talking about just like financial operations, practice management and the value of that to really streamline processes. I love what you said to around designing a practice management system in a platform that gets out in front of those issues. And it's designed as like, hey, you can't move to this next step until this is done.

Ethan 00:20:57 So you're almost like putting guardrails there. I think from our lens, once that sort of like operational infrastructure is in place, you now start how... you kind of have ways to then track and monitor performance. And that kind of then maybe goes back a little bit to the Flychain side of the fence where, you know, we talk about the importance of financial visibility and making data driven decisions. I think the cool thing and why we love working and partnering with practice management systems, EMRs, even billers is, we can rely on good processes, but also good data.

Ethan 00:21:34 And what I mean by that is from the Flychain lens, we want to make sure all of your financials are completely buttoned up. We have a really good understanding of net profit, gross profit, billing trends, what does seasonality look like. And the whole goal there is the operational and unique elements of ABA are very correlated to financial health. And we'll see folks that\... Some of our customers that like they have really good businesses, really good margins. And unfortunately, it's like the rule of three, maybe deductible season hits, you're in the summer, or it's holiday season, then someone COVID hits your center, and you have to shut down. And there's just so much that's unexpected.

Ethan 00:22:18 And so for us, so much of what we try and do is really relate that operational billing trends that we see within your business to that financial performance so that you can actually get through some of those, I think, unique challenges that ABA therapy businesses often face, and sometimes aren't aware that those things will actually continue to happen. We kind of say like, oftentimes helpful to run your business under that principle of like Murphy's law, like whatever goes wrong will go wrong. And I think if you actually... it sounds like pretty pessimistic, but if you run your business with that assumption, I think you'll be really resilient and it all starts with the right operations and then interpreting that operational data, interpreting your financial data again to set yourself up with a view to the future versus being too, I think, retroactive or responsive to things.

Ethan 00:23:11 Yeah, I don't know. I know we're doing different things but related. I'd be curious on your end to see working with so many customers over the years and how at Office Puzzle, how would they think about financial management as it relates to that like sort of practice management side? I know you might not have gone below that line too much.

Charlene 00:23:32 Yeah. You know, I can only speak anecdotally on this one. I think that it's really funny that people can be, and I myself am in this bucket. I am incredibly analytical. I can geek out about data. When you start talking about the operational data, I could spend so much time thinking about and analyzing. I do that with my own team. And there's some weird line when it crosses over into financial. There's something, whether it's like a discomfort or insecurity, and I find that is something similar with customers where sometimes they're very proficient in data analysis.

Charlene 00:24:11 And so that kind of like forward looking of looking at the operations, looking at how things are going, probably pretty well equipped to do that. And yet not everyone is as comfortable to move into the financial part. And so, I would say that I haven't experienced many that have done that well. And that's just been a continued pain point because there's some level of discomfort. I'm not a therapist. I can't figure out what it is that's causing that, but there's a shift. There's like a chasm that some people are just not able to cross. So I do... having the right people in place to help.

Ethan 00:24:47 I think it's very much like part of our respective duty here to then bring that and bring it to them and make those numbers make sense, so you aren't afraid of the numbers. I couldn't agree more. Our customers are really smart and really good at interpreting data. They just often haven't seen the financial data before. I probably would be really poor at analyzing clinical data because I wouldn't know what to see or interpret. I think you're right. Part of this is bridging that operational and financial gap so we can turn this into actionable insights to clinician-minded owners is often who we're working with.

Charlene 00:25:21 Yeah, definitely.

Ethan 00:25:23 Yeah, yeah. So just as a bit of a segue, and I know this is something that I think is a little near and dear to your heart. And we love partnering with folks like Office Puzzle. We get better data. It helps us. Rising tides raise all ships. I'll say that a million times. Like having the right data and mapping the right data does provide a lot of insights to our customers. I'd love to kind of switch gears a little bit and pick your brain around leadership and culture. Because again, I think they're all very related. Having a culture that is interested in streamlining operations probably from the top down is paramount in so many of these organizations.

Ethan 00:26:05 But yeah, I'd love to just pick your brain or if you want to share some thoughts around humanizing that operational discussion that we've been having, the link to culture and retention and business success. So yeah, I'll open the floor. I'd love to hear your thoughts on that because I know you've spent a lot of time thinking about this and working through this with customers.

Charlene 00:26:29 Yeah, absolutely. I think the funny thing is the connection to ABA. So, I will start with operations and culture. It's like the art and science. So, we think about operations as maybe more of the scientific structured approach to things. I don't think that you can run any business without good and strong operations. But operations takes people to actually follow the process. So I learned very early in my career, I can design the most beautiful process. It is just, I mean, state of the art. And it wasn't until I learned how to get people to actually buy into and adopt that process and understand why it would help them, that it actually started to take hold.

Charlene 00:27:14 So I would just have all these things that I then had to do myself because I didn't understand the leadership or the change management side of it. So that really started to shift my perspective of you can't have one without the other and really figuring out what is that balance and what is that tension. And I think the reason in this environment, it's so important to have strong leadership and culture is that you are operating on incredibly thin margins. You are relying on a number of people to adhere to certain requirements that are not up for debate, that are very rigid and structured and required in order to get those Medicaid reimbursements. And you need to rely on them to want to follow those protocols.

Charlene 00:27:58 So I have found that when you develop a strong culture through -- and culture by the way, for me is not pizza and perks. Culture is truly like the way that people work when no one's looking, the values that you all share, the mission that you're going after. When you have that strong culture, it comes with really strong communication, being more direct and transparent, helping to create that environment of mission and margins are not enemies and we're going to talk about this. We're going to talk about it very transparently.

Charlene 00:28:30 And when you do that and you help people understand why, why do we have to follow this step to the T versus here's where we've got some more flexibility and we want to empower you to help us not only adopt this but to evolve it and improve it You get people who have ownership in the company and that ownership can exist at all different levels. So I'm very, very passionate about culture because I think it is that secret weapon that unlocks great operations.

Ethan 00:28:57 I love that. Yeah. It's so interesting too. Like we'll see businesses that might not have the best culture and just by setting the tone in an incorrect manner, bad culture can lead to like higher staff turnover that's going to create a higher financial burden. Both because you need to replace those folks and train them and there's costs associated with that, but also, probably if you're another employee there and you see your friends leave -- I don't want to call it be a poison pill, but I think it's really that top-down leadership approach that by setting the tone for the organization, keeping your employees seen, heard, happy, healthy, actually has insanely positive financial repercussions that might not be so direct.

Ethan 00:29:45 There are opportunity costs that we're talking about when somebody leaves as an example. And then also, I'd say, I think from your lens, Charlene, in particular, doing right by your team and clients is good business. And I think that also then paints the picture of your organization in the eyes of your clients as well. If those employees and the culture that you've put, you've now created a very welcoming environment and families and kiddos, I think, like stick with you longer and really believe in the businesses that you're building.

Charlene 00:30:19 Yeah, I think absolutely. I mean, you can tie culture directly to the success of a business financially as well. And you talked about staff turnover and opportunity cost of replacement. Let's not forget the cost of keeping someone who is not bought into what you're doing, feels resentful for the way that the company runs, is not following process, maybe, at this point, is so burned out, they're not delivering great patient care. So even people who stick around, you don't have to train new employees, you don't have to bring new people in and recruit, but are they costing you money in the sense that they're not following the steps and now you're getting more denials? Maybe you're not getting great patient care and now your patients are turning over. So I think that there's something really important just from the goodness of being like a good person and good employer, but it also directly ties to financial and patient outcomes.

Ethan 00:31:12 Yeah. On that same note, like we'd love to get your thoughts around like maybe best practices. Some things that we've seen or would be, especially if you've got employees that might feel a little burnt out or not buying into that vision. How can you try and get that person a little bit more bought in? I know every person is very different. Like we're a people driven business and you can't force someone to do something they don't want. But, you know, is it transparency? Is it like meeting with them more regularly and asking about how things are going? Yeah. Are there any things that you've seen when it comes to that sort of like human capital management side of this business that has worked or maybe things that haven't worked?

Charlene 00:31:55 Yeah, it's two things. It's authenticity and transparency. People want to know what's going on. And of course, you know, there are times where you have to be mindful with what you communicate and how you communicate. But people understand when they're not being told something. And when there's a void in communication, people make up their own stories. So that piece is critical. The other side of that, though, you've got to walk the walk. If you expect something from your team, you have to be willing to operate in that same manner.

Charlene 00:32:26 So the second that people feel that you're excluded from that, or you say that our mission is to serve our clients and yet they regularly see you taking action that's cutting corners and impacting client care, you've created mistrust in your team. And so if you're bringing in teammates who are really aligned to your vision, they're excited about what you're doing and the mission of serving your patients and then you're not doing that, you're going to lose them, whether that's lose them emotionally and culturally in the moment or actually leaving the company.

Ethan 00:32:59 Yeah, probably one happens. And actually, that's a good point too. If you see someone that is losing steam, feeling overworked, not having the maybe most positive attitude -- everyone has their bad days. But I think it's like, hey, that's a good point in time to talk with that person and check in and make sure, are you happy here? What can we do to make you feel more at home? Do you need more support? Are you overworked? Do you not know how to do things? I think, again, transparency. It's kind of like running any business, honestly. We have to do the same thing. I just think that clinicians have different minds and hearts, and each one's different. And I think it's really the impetus of that leadership team to check in regularly and make sure they're adhering to culture and you're leading by example, as you mentioned.

Charlene 00:33:50 And I think too, it's about not losing... you know, it's hard in the moment. You start with the heart, and you begin to get distracted by other things. Maybe it's not even -- it's not greed. It's not like, I want to be successful in financial, but you're struggling and you don't have the energy to be able to focus on the heart aspect of it. But just like you're thinking about your clients as humans and what do they need as humans, you have to think about your team the exact same way. So we are all a collection of humans. Businesses are run by, well, right now, run by humans for now. So we need to understand that each person has their good days, their bad days, their struggles, and be empathetic. That's the core of what we're doing.

Ethan 00:34:36 Yeah. Empathy is so important. And we have, I think a lot of empathy, and I've really grown that empathy realizing our customers have the biggest hearts. They know how to run these businesses, care for kiddos, and it's our respective jobs to make their lives easier. And it's a good reminder. I think thriving isn't just about systems, spreadsheets that, I think, you and I spend a lot of time in. But it's about people at the end of the day. And that's why we said earlier on, banks can't lend to ABA businesses because they don't have asset. They don't own real estate or whatever.

Ethan 00:35:13 But if you think about\... I always challenge our customers to think about their humans as their assets. You can't collateralize a human. But what you can do is really treat them as those assets of your business, which are the lifeblood, much like billing is the lifeblood. They are actually the ones that are on the ground doing God's work, as we like to say. Yeah, awesome. Maybe the kind of the last topic we wanted to chat through is really just like Office Puzzle and Flychain.

Ethan 00:35:41 This is not meant to be a plug on our respective services, but I think it's cool now that we've started working together to really see the power of this type of partnership. Charlene, maybe if you could share a little bit around some of the work that you do today and how -- I can kind of relate that to the work that we do at Flychain because they are so complimentary. But yeah, tell us a little bit more just about like Office Puzzle, your customers, how you're working with them today, because I think you have a great story.

Charlene 00:36:15 Yeah, absolutely. So Office Puzzle is practice management and data collection. So we really like to think end to end from client intake through billing. And the unique about Office Puzzle is we're trying... we find that balance between flexibility and control, ensuring that we've got the right structure in place to minimize errors and share compliance, but allowing our customers to set up the operations of their company through configuration to the way that they want to run it. So we are not clinicians. We are not the experts in that sense. And we're also not the owners of the company.

Charlene 00:36:54 And so building in the safeguards and guardrails like you mentioned but allowing the flexibility to operate in the unique models that we've seen our customers operate. What I love about it is that it is integrated where when you get in your client information, then you schedule the appointment, you've got your notes automatically ready to go and it'll prompt you. It'll tell you that you've got that note to take. You set up your service plan, your data collection, all of that data is flowing through.

Charlene 00:37:23 And if we think about data, not only is that data then helping you with the daily operations, but that's all recorded in the back end. And so you're able to then go look at reports and you've got all of that operational data captured. So we talk about wanting to find deficiencies and analyze results of your operational metrics. This is doing it for you. You don't have to think about it. It's like data collection on your business. And it's all just captured throughout the process of your day to day.

Ethan 00:37:52 Yeah, I love that. What we love is when systems can talk to each other. And so, I think even if you flashback maybe 2-3 years, data interoperability among these systems was, from my humble perspective, almost virtually non-existent. And what I mean by that is liberating some of that revenue, granular data from a practice management system, which is also going to have things in there like utilization, very important metrics to track. Why we love that, now we can talk to each other. We can bring data from a practice management system and map that to granular expenses as an example.

Ethan 00:38:32 So we can give you a clearer picture on profitability per CPT code, per service line. And we can't do that without the buy-in and that data exchange where that data lives on that most granular of levels. And so again, it's us working together behind the scenes, honestly, to help improve that outcome both financially and operationally, sort of the one plus one equals three mentality that we have here.

Charlene 00:39:00 It helps tell a complete story. Otherwise, you've got one half and then the other half, they're disjointed and you're missing something very special about that story without it.

Ethan 00:39:10 Yeah, totally. I can't tell you how many times we'll look at their practice management revenue data and things look good, but then we map it to expenses and also look at the reimbursement rate and we'll say, "Hey, did you know that you actually lose money every single time you see a patient under this like, in a contract." And again, without the combination of those two things, you could probably get there, but it would be incredibly difficult, time-consuming manual. And now our oftentimes... clinician owners are trying to have to figure that out. And we don't want them wasting time on that. It's why we exist as companies.

Ethan 00:39:45 Yeah. The shared philosophy... like thriving on thin margin, means clarity and I think it means balance, means prudent growth. And all of these contribute to, I think, really, really resilient businesses and awesome care, quality care. Well, this has been awesome. I really appreciate you joining. Just in terms of kind of wrapping up here, maybe some like call to actions. We always like to end with that. We do fundamentally believe that thriving means disciplined operators, that culture that you really hit the nail on the head with, financial visibility. That's, you know, don't need to talk about Flychain anymore. But yeah, any takeaways that you wanted to leave our customers with around yourself, Office Puzzle, how they can get in touch with you, like anything like that, I think would be great.

Charlene 00:40:40 Yeah, I'd say one more takeaway I'd offer is start before you think you need to. Often people will wait until they're like, well, once I'm this big, then I actually need that. Find the tools and those tools might evolve over time, but find the tools early on that will set you up for success over the long term so that you're not trying to figure it out when you've actually proven success and now, you're a little bit more busy. As far as finding Office Puzzle, officepuzzle.com. Of course, we're happy to chat with you. But yeah, we feel very passionate about this field, and we really want to support the people who are providing the care.

Ethan 00:41:19 I love it. Yeah. We're grateful for the things that you're doing, grateful for our shared customers. Yeah, we'd love to chat with anyone tuning in here to double down. I think we just scratched the surface. We try not to get too in the weeds on these things, but here's a lot more we can chat through and would love to do this again sometime, Charlene.

Charlene 00:41:39 Sounds good.

Ethan 00:41:41 Well, appreciate your time and have a wonderful day.

Charlene 00:41:44 Thanks. You too.

Ethan 00:41:45 All right. Take care.

Simone 00:41:46 Thanks for tuning in to the Flychain Reaction. If you'd like to keep the conversation going, feel free to contact us at info@flychain.us or schedule a demo through our website at www.flychain.us. See you next time!