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00:00:01
Rafael Salazar, ProActive Rehabilitation & Wellness and The Better Outcomes Show
18 Plays9 months ago
In this episode, Steven sits down with Rafi Salazar, CEO & President of ProActive Rehabilitation & Wellness and Host of Better Outcomes Show
Learn more about SaRA Health: https://www.sarahealth.com/
Check out ProActive Rehabilitation & Wellness: https://pro-activehealth.com/
The Better Outcomes Show: https://rehabupracticesolutions.com/betteroutcomes/
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Transcript
Introduction to 'The Disruptors' Podcast
00:00:02
Speaker
Welcome to another episode of The Disruptors, where we're arming you with the tools you need to innovate within the physical therapy space by highlighting those who have come before you. I'm your host, Stephen Cohen. Now, let's get into it. Welcome back to The Disruptors podcast.
Meet Rafi Salazar: Healthcare Innovator
00:00:18
Speaker
I am so excited to have Rafi Salazar on with us today and a brief intro on Rafi.
00:00:26
Speaker
His career trajectory has included 12 plus years of experience in healthcare care management, clinical operations, programmatic development, marketing, and business development. He even spent some time as an assistant professor in a graduate program of occupational therapy and has served on numerous boards and regulatory committees. He is the host of the Better Outcomes show, and he's also the author of the book, Better Outcomes, A Guide to Humanizing Healthcare.
00:00:52
Speaker
Today, Rafi hopes healthcare clinics, organizations, and healthcare care technology startups develop effective patient engagement and positioning strategies through his consulting work. He also leverages his experience as a professor and academic to speak and train on the topics around humanizing the healthcare care experience, healthcare technology, and innovation.
Career Inspirations and Influences
00:01:15
Speaker
In addition, Rafi also owns and operates Proactive Rehabilitation and Wellness, a multidisciplinary outpatient clinic treating patients with musculoskeletal pain, and one that I've been lucky enough to visit in person in wonderful Augusta, Georgia, which is about to get much busier here. without too much longer. So with that, Ravi, thank you. I'm excited to have you. And if you don't mind, I say we we jump right into it. Sure. Yeah, that sounds great. Okay. I like to start from the beginning, right? And go back to more of
00:01:55
Speaker
your why that you at least got into the the therapy world. So let's just, let's start there and the background of of of why you got into it. And if you could make some a little bit of Hal, that wouldn't be too terrible either. Sure. yeah Yeah. So, um, growing up, I was kind of split in the career path. My dad is an engineer and he wanted one of his kids to be like a chemical engineer or something like that. I was pretty good at science and math.
00:02:22
Speaker
figured, you know, that seemed like a decent you can make money as an engineer, right? um My grandfather, on the other hand, was a vascular surgeon. And I got to spend some time with him in the summers when I was young, you know, 1011 12 and really thought, man, there's something cool about like having a relationship, he ran his own uh, small private vascular surgery practice in Ohio. And the people that came in like knew, Hey, Dr. Suarez, and they had this conversation, how are the kids going? Like he saw these people over a period of time and he he built like real relationships with them. Um, and I thought that was super, super cool. And as we were, as I was growing up, I kind of realized like,
00:03:05
Speaker
maybe I'm sure people that are in engineering don't get mad at me engineers, like I'm sure they have those kind of relationships with their clients in some circles. But um I just did not like the idea of sitting like at a cubicle crunching numbers on an Excel sheet all day. I wanted to do
Pathway to Occupational Therapy
00:03:22
Speaker
something with people. So um I thought being young and not lacking any confidence. I was like, well, my grandfather's a vascular surgeon, maybe I'll just go and like be a neurosurgeon. Like that can't be too much more difficult, right? And talking to my grandfather about it, he was like, well, you know, you know, healthcare is changing. If you really want work life balance, you know, going you like getting your MD is probably um not the way to go. At that point in time, he was like getting ready to wind down his practice. And a lot of that, the drive behind that was just because of regulatory burden and you couldn't treat the way he wanted to treat, right?
00:03:58
Speaker
So it got me thinking, like the summer before my senior year, like leading up to that in high school, I was like, okay, want to go in healthcare, care don't want to go in medicine because it sounds like that's just a recipe for burnout. And just so happened that I went fishing down to the the lovely Savannah River right here behind the waterworks in Augusta, Georgia.
00:04:20
Speaker
slipped and fell in a bottle, um not my bottle, just a bottle that somebody had left in the river and i lacerated my flexor tendon in my left hand and my thumb and ended up landing myself in an OT clinic, in a hand clinic for you know three times a week for the balance of the summer before my senior year in high school and then a little bit into that first part of that that school year. and I was like, man, this is this is cool. This is really, really cool.
00:04:46
Speaker
And it kind of set me on the path of, OK, I want to do hand therapy. And that's kind of what got me into the therapy world. From there, I kind of just connected with the therapists that worked with me when I was done, when I had graduated therapy and was off in the world. I reached back out to her and said, hey, I'm i'm thinking about going into occupational therapy as a career field.
00:05:05
Speaker
would you mind, you know, me shadowing you? And I was able to get kind of get in and do do a little bit of everything, see some of the outpatients, see some of the inpatient, kind of see some of the PTs do their thing, see some of the OTs do their thing. And, um yeah, the rest is history, kind of got into the into the program and at mc well was MCG, now it's Augusta University, and the OT department graduated in 2012 and have been running ever since.
00:05:30
Speaker
I want to touch on a couple things.
Proactive Learning in Healthcare
00:05:33
Speaker
cause There's a couple, there's a lot of nuggets in there, but ah a couple in particular. So you proactively asked the, you're treating OT if you could shadow her. Oh yeah, for sure. And she was fine with it, right? She probably was like, probably kind of honored, right? Yeah, she was. yeah And you're like, oh, yeah, sure, of of course, right? you you you can You can do that. i
00:06:03
Speaker
ah there There's a stigma around people thinking that ah the others don't want to help them, right? ah so wrong in so many cases, right? Like, sure. And does it doesn't happen. Yes, of course. You know, there are are people that are having bad days everywhere. But i I want to highlight that it was just as simple as you having the courage to ask, right? Yeah. I mean, growing up, my dad always said, he said this multiple times. He's like, you always ask the worst thing they say is no. And then you're in the same position that you were in now. Like, nothing has changed.
00:06:42
Speaker
Except for now, you don't have to put a bunch of mind space towards what could happen. Like, well, I already know what the outcome is, so now I can move forward. right exactly that's I appreciate that. and And then also on your you grandfather and those those real relationships that you get yeah know that you saw get built. and And yeah, I i think your, you know, for all the engineers out there, and I guess I'm about to lump in consultants. Yeah, I'd say there were a lot of those relationships that were very surface level. And, you know, it kind of started with the project and ended with the project. And, you know, maybe you get a like on LinkedIn every six months, right? And then that's, that's about it. And that's fine. Like you, you that there's nothing wrong with that.
00:07:33
Speaker
But when I see the yeah when I think of my relationship with my physical therapist that I've had over the course of the last you two three decades.
00:07:45
Speaker
It's very different, right? you're You're with them one-on-one, right? And with a lot of time note, it's just you and another human, right? And you're vulnerable as a patient. It's very, very different. So I love that you highlighted those, you know, among among other things, the the desire for real relationships and how you just stack and look what happened afterwards, right?
00:08:15
Speaker
And so know my my typical next question is, although the Y behind PT, and you you covered that as well, right? With ah the the flexor tendon and and that injury. I don't know if you want to add any more to that or if you just want to continue rolling.
00:08:31
Speaker
Yeah, no, I mean, i I really liked the fact that it was, you know, one of the things that even what my grandfather said was a limitation in in his work as a surgeon was like, he saw people, you know, for like an assessment, you know, maybe for pre-op, then he'd see him immediately post-operative, and then like three or four months later. So my grandfather was great at making, you know, making the most out of that time and trying to build a real relationship.
00:08:54
Speaker
But when you're in a PT clinic, you know, two times a week for like 12 weeks, it's much more intense. You know, like you're seeing somebody almost every other day. Um, the relationship gets very deep, very quickly. And I, I kind of was drawn to that. And, and, you
Building Relationships in Healthcare
00:09:10
Speaker
know, go ahead. We'll, we'll take a sidebar for a little, or a little bit of a tangent. That that's really the one place in healthcare care that happens, right? Like it's therapy. That's it. Now, if you.
00:09:23
Speaker
Look at therapy like the broadest sense, right? Looking at both the mental and physical side, then yeah, that that definitely encapsulates the only interactions that are both near term in terms of cadence and even in a single visit is more than 20 minutes, unless you're in like a direct primary care, like some other cash pay model. It just, it doesn't happen. I think that's, I think it's really special. Uh, and why, you know, why I love what we do and, and, and trying to help ah those that are doing the hard, hard work of creating those relationships. I mean, it's not just a pure, like, all right, come in. All right. Stick you with a needle and and I'm out and not to, to, you know, to get back in six months or whatever.
00:10:13
Speaker
Yeah, degrading the other practices, but um I mean, you have the both the challenge and the opportunity of of behavior change, yeah right? that's That's tough. That's tough. There's billions of dollars been invested into diet and exercise and all those other things, right? If not tens, maybe it's even good hundreds of billions now, right? And the companies that are trying to impact that and yeah, try to do that every single day. I i think it's really cool. It's why I love working.
00:10:46
Speaker
with with this group. and Maybe that leads us a little bit into talking about your why behind what you're doing now. so right your're you're You're not only treating, but you're also helping health tech companies. You're advising others. You're teaching. right You've got ah just a couple of irons that in the in the fire. ah as yeah as well as you a very full van right yeah to take care of. so Walk me through that that transition.
00:11:22
Speaker
right and both thought I definitely want to talk about the how. You did it, but I'd love to even know the why. Where does the energy come from and then where are you putting that energy towards?
00:11:32
Speaker
Sure, yeah. So I guess it all started back when I was, one of one of my first jobs was like the dream job for ah for an outpatient clinician.
VA Experience and Relationship-Based Care
00:11:42
Speaker
And it was, well, maybe it's a dream job, depending on your point of view. It was in an outpatient specialty rehab clinic for the Department of Veterans Affairs, and um which ah I consider the best job in the world for a staff clinician because you didn't have to worry about insurance.
00:11:59
Speaker
You were dealing with the federal government, which is never fun, but the patients, you want to talk about building relationships with patients. It was awesome. there The VA is very unique in that. they are for the most part ah the majority of the people that we saw like received all their care at the VA. So there was like this community within the community in the VA. a It was just really it was just a unique experience and then ah because you don't have to worry about insurance and because the VA is puts a lot of money rightly so in innovation and trying to get you know the best care for the for those who served us.
00:12:32
Speaker
you get the access to do super cool things. Like I was doing telehealth back in 2010, no, 2012, 2013 is when I started there. So 2013, 2014, we were doing telehealth with the CBOCs, which was the community-based outpatient centers, before it was like a billable, cool thing. It was just one of those, we had veterans that lived, I'm an Augusta, we had a CBOC in Athens, which is a couple hours away, and all they had there was primary care. um So it just made sense like, why don't we just screen these people before they have to drive in for two and a half hours for an OT eval or something like that. So we were doing telehealth, you know, consultations, you know, 12 years ago, it was super, super cool. um So there was that aspect. um
00:13:16
Speaker
One of the big things that I became very clear, very aware of while I was there, I was there 2013 is when I when I said I started. I think around 2014 is when the the fit hit the shan over the VA and it started with the Phoenix VA. I don't remember if if you remember this in the news. um But there's a big scandal, it broke into Phoenix VA first, and then they realized that it was more of a systemic issue across across the entire Department of Veterans Affairs and it really revolved around scheduling. You know, there were, there were veterans that were getting put on like paper waitlist quote unquote, and then never getting back for appointments. It was a huge, huge deal. um And as someone who was there,
00:13:58
Speaker
um It was a huge deal for the veterans who were coming in because they were very, um, disgruntled to say the least. They really just didn't trust the VA. They didn't trust that the VA had their best intentions at heart. And that carried on to not just like the VA, but it was like, you, you're part of the VA. a I don't trust you. Right. So there was that aspect. And then the other aspect was like, people were just leaving, you know, good employees, good clinicians, people with a lot of experience didn't want to be tied up in that and they left.
00:14:28
Speaker
So about that time, 2014-ish, late 2014, early 2015, I had been bumped into, I can't remember what they had called it, like senior executive leadership development or something like that. They put us through a bunch of trainings and and things like that. One of the things that they um that was kind of like a last ditch effort almost, that they wanted our group, our cohort of like leaders in development to to roll out at the VA, a was something called relationship-based care. And the entire idea was like, if the work culture sucks, the care is going to suck, the patients are going to leave, right? And it's not going to be good for anybody. So the yeah the whole idea is we're going to build a strong relationship within the treatment team. And that will carry over to the way that we communicate with veterans and their families. And it's going to make sure that you know veterans not only trust the care that they're the advice and the recommendations that are being given, but that they're going to be more likely to show up and and all of that.
00:15:24
Speaker
So I was very fortunate to be able to do that um and really kind of spearhead leading that, rolling that out in a couple of the units within um RVA here in Augusta. And it was not long after that we started rolling that out that we saw some some real improvements and the the entrepreneurial little spaz in my brain decided like, this has a lot of application.
00:15:48
Speaker
outside of like a federal government health system that's floundering and failing. right like this The idea of relationships being leveraged to improve business metrics, which sounds really like callous when you say it, but had a lot of applicability to the private healthcare market, and I could see that people would be willing to pay for that. right So about the time that we were done rolling that out and I had kind of seen and documented along the way what was working, what wasn't working, some of the things that I saw in the program that we were putting out, which was at the time a trademark program. and
00:16:25
Speaker
if I can't remember who put it on some big consulting firm that put it on forum. I like put down some things on paper that I kind of thought were could have been done better and probably could have been done differently specific for rehab because we're different than like we just said ortho or another specialty where there's like longer periods of time in between care or inpatient where it's like super intense for like three or four days and then your discharge planning. The rehab was a little different. So I decided what I was going to do is I was going to basically do a course. I was going to make it a CEU course and I was going to call it something like relationship-based rehabilitation. And it was all going to be about leveraging relationships to improve
00:17:09
Speaker
Uh, no show rates and cancellation rates and patient engagement and all of that. So build rehab you on the side. Um, during my, like in my evening hours when I was at the VA.
00:17:21
Speaker
Um, and then about that time, like a couple of years ago by building this course, thinking about what, like, what's the next steps. Um, I got, uh, I was part of this leadership development thing was like, okay, we're going to prepare you when at the end of this two years, whatever, you're going to have the skills. We're going to have you qualified to take, you know, a jump in your series. Everything in the, in the federal government is like your pay scales and your, your GS scale or whatever. Um, which was attractive to me because I was trying to provide for my family. Right.
Transition to Consulting and LinkedIn Success
00:17:51
Speaker
And so 2016-ish, 2017-ish rolls around, finished the program. I'm like, OK, I'm going to become like a manager here at the VM. I'm going to really be able to affect change. And got passed over for a job um that I was clearly more more qualified for than the person who got the job. And when I was talking to part of this leadership development series, I was like, OK, we're going to give you a mentor. So I was talking to a mentor about it. And I was like like, this is not right.
00:18:19
Speaker
you know, like, obviously, I know, I'm, I'm, I have more skills, I've demonstrated more skills and competence in this other individual. And they said, well, you know, they've been here for 17 years, you've only been here for, you know, three or four years. um Don't worry about it.
00:18:33
Speaker
And then this person said, and you worry about it. And you will know whether the kicker was out, you know, part of me was like, well, that's not right. That shouldn't happen. So I was already thinking in the back of my mind, like, well, then I'm going to go find a place that, that values what I have to bring to the table. But the kicker was on the way out the door. The guy was like, well, you're a Hispanic male. And I said, yeah, so, and he said, give enough time. We'll give you something. And I was like,
00:18:56
Speaker
like I'm not going to be an affirmative action case for anybody. um So I left his office with like the clear intention of like, I'm just going to go apply to anywhere and everywhere that's going to take what I've got to offer. And my dad being the super innovative guy that he is. like he He got me on LinkedIn. I was not on LinkedIn before my dad was on LinkedIn. He was like, you need to get on LinkedIn and you will get a job from there. And I was like, sure, whatever. um So I hopped on my LinkedIn and like within two weeks, a connection of a connection um had reached out to me and said, hey,
00:19:29
Speaker
we're looking for an occupational therapist in Augusta, Georgia, who's got some of the skills that you've got. I had done some training in like project management, not Lean Six Sigma, I didn't go get all like a black belt, but I did some of the training and kind of understood some of the principles, some policy analytics. um And they said, we're doing this project with the state of Georgia with the Department of Behavioral Health, and we need an OT consultant, would you be interested? And I said, sure, like, let's have a have a conversation. So um All via LinkedIn messaging. One thing led to another, met ah the the director of the project at a Starbucks here in Augusta. um He basically pitched me on this idea of they were they were doing a lot of programmatic work for the Department of Behavioral Health. um And was I interested? I said, sure. I said, I guess it depends on how much the pay is, how long the job is, because it's consulting. you know And the big thing about consultants is like
00:20:19
Speaker
the The running joke is like a consultant to someone always in between jobs, right? Like we're always moving from project to project. um And I said, well, how long? He said, well, it's six months and the pay was like, I don't know, like 130 grand. It was going to be like more than I would make in two years of the VA. And I was like, done and done. Like you don't have to tell me anymore. So, um you know, signed the contract, put my two weeks into the VA and left.
00:20:46
Speaker
And that that experience was freaking awesome. It was supposed to be a six month contract, ended up being like three years, but it ex exposed me to like higher level, um really like advisory work. Like I was briefing people from the governor's office about the project that we were doing and where we were at and the steps we were putting in place, how we were doing some knowledge translation.
00:21:09
Speaker
um And it really opened my eyes to like the impact that you can have at that level. You know, even as as a manager at the VA, the most I could have done is effect change for that clinic maybe or that department, which would, granted have been a couple hundred patients, maybe a thousand patients in a year. I mean, when I was doing this consulting project for for the department of behavioral health, like I was writing policies on case management and and things like that that were affecting literally tens of thousands of people.
00:21:38
Speaker
um So I really, really liked that. um And I mean, obviously, like financially, it was ah it was a good move too. um And it was at that point where I started really putting the pieces together with RehabU and what I was doing, I was like this is like, a course is nice, but really being able to impact systems is really what I want. And like big companies, big healthcare care systems aren't buying a course from like Raffi Salazar on the internet. you know like They're just not doing that.
00:22:07
Speaker
So I pivoted the the work that I was doing to like patient engagement strategy for healthcare organizations. And you know, one thing has led to another that kind of moved into like healthcare care tech and stuff, but that's really kind of what made me shift from like staff clinician to consultant. And that kind of brought me to the, at least the consulting leg of the career.
00:22:26
Speaker
I feel like I just talk a lot. Sorry about that. No, that's perfect. i i Honestly, I think it's, again, for for what we're trying to accomplish with with this podcast, right it's like it's not always perfect. And when one door shuts, another one opens. There's actually a lot that you covered there.
00:22:44
Speaker
um and Yeah, when one, yeah, when one door shuts another another one open, try to find the silver lining to it. um And yeah, this maybe I think the LinkedIn in particular, I wrote that down, right? Like, oh, I love getting the LinkedIn connection requests from a PT that like, I'm number 46. Like, yeah. man like ah he and You need to get those numbers up. You you get those numbers up ah you should have more than 46 connections. And I don't know if we've talked about this, my wife's a nurse practitioner. And yeah, she maybe has like 50 or 60. And ah you'd be surprised like how many opportunities can come through, especially LinkedIn for that. i mean
00:23:30
Speaker
One, they say you know like most people get jobs now. like the The referrals are not from like your close circle of friends. It's like those second and third degrees of connection that you have. Like, oh, my buddy knows somebody across town that's looking for this. So even if you're looking for like another PT job, it benefits you to have just a ton of people in that network that are maybe not even people that you talk to ah weekly or regularly, but they're like friends of friends or connections of connections. Because that those weak ties is where a lot of opportunities happen.
00:23:58
Speaker
Completely agree. We've seen that on business development or even on hiring. Our chief outcomes officer was a LinkedIn connection of a LinkedIn connection. They had a strong relationship. I talked to this guy. I said, oh, you should meet Amanda. Okay. Yeah, let's do it. A few years later, she was an advisor for a while and joined.
00:24:23
Speaker
ah yeah that's That's how that happens. So yeah, I think you' you're absolutely right. And some advice, immediate taxable advice is grow your LinkedIn network. You don't have to post every day, right? You don't have to do any of that. Just simply get the people that are actually in your network in your LinkedIn network. And so that way, if you ever need it or it can never help someone else, it's there and it's frictionless, right? Instead of trying to build it from scratch, if having forbid something happens and you're getting off. The last thing you want to do is be like, oh, I need a job. Time to start digging. Yeah. Time to do this LinkedIn thing. No. Set the stage beforehand.
Executive Communication Skills
00:25:01
Speaker
When you're talking about briefing the governor's staff and going through that,
00:25:07
Speaker
I'd have to imagine your your executive communication right and and those skills, which are so incredibly important, right is as you know. you Do you mind going into maybe even like a couple ah couple examples? Maybe one thing that was like a really nice win for you, like, oh, like this is This is like now how I do executive communication every time, and maybe even a hard learning, a hard lesson um with that. Because I think a lot of people listening write, hey, how do I talk to my boss about this? How do I think about, i want I want to get this program rolled out. Now, how do I get someone four or five levels up to to get excited about this and green light it? So I think if there's anything that's there, both, you know,
00:25:55
Speaker
good hard-earned lesson and a a nice win. if you If you could share a couple examples that'd be great. Yeah, I think while they're linked. So hard lesson first, and then how I do things now. So it's very easy. And I think Chip and Dan Heath read about this a little bit in one of their books. Maybe it's made to stick or switch. Made to stick. Made to stick or switch. I've read almost every book that those two have written together. It's awesome. But in one of those books. Have you read both streams? Yes. Yeah, yeah. Oh. It's a good one.
00:26:26
Speaker
um Yeah, but we could go down the road hole of Chip and Dan Heath. I think it was made to stake. He talks about the curse of knowledge and how a lot of times people that have technical expertise um can almost not remember what it's like to not know what you know, right? Like that's just, it sounds really douchey to say like, I'm so smart. I forget what it's like not to know what I know. But especially if you're not, if you're communicating with people that are outside of your area of expertise, like at executive meetings, you're you're dealing with like a marketing officer or business development officer or somebody that like maybe in finance that really looks at rehab as just some numbers on a spreadsheet and what it means for the bottom line.
00:27:11
Speaker
like all the technical stuff that you know, they don't know any of it. So they're looking at, you have to realize that when you're having that communication or giving that presentation or making a pitch or whatever it is,
00:27:23
Speaker
Y'all are coming to it from two very different vantage points, so you need to be able to tailor what you're what you're communicating to that person. yeah Essentially, it's positioning. but um so One of the early fails is we were doing something. it was ah It was a project about the way we were going. The state was going to manage ah case management through support coordination for the integrated clinical support team, which is a bunch of fancy stuff. Basically what we were trying to do is streamline the way um cases were managed from ah kind of the Medicaid waiver system here in Georgia for people with ah intellectual and developmental disabilities. And I wrote this brief out and a lot of, I mean, technically it was sound, clinically it was sound. It was 28 pages. It was like you could, ah the state is still using it to my knowledge. Last time I checked to someone check with somebody um as a framework for what for what's going on with case management.
00:28:16
Speaker
um So technically sound, it was awesome. Put it together and I basically translated that onto like a PowerPoint. And about two minutes in, they were like glazed over eyes. And people were like, yeah like i was I was talking with somebody that they were managing the budget for this this department or this program. And like they didn't really care about the clinical. I mean, they did care about the clinical outcomes. a But it wasn't pertinent to their job. you know They wanted to make sure that like this was not going to bankrupt the the department. Or they were going to then not lose anything on this investment. Or what did this mean for provider um recruitment and retention within the state?
00:28:53
Speaker
so what I do now as a result of that experience, they were very gracious. They were like, we can tell you're a very smart guy and you know what you're talking about, but this is really what we care about. And they gave me bullet points. We want to know this stat, we want to know this outcome, we want to know boom, boom, boom, boom, boom. And basically what I do now is I look at who's the stakeholder, who's the audience,
00:29:16
Speaker
What is truly valuable to them? Because especially in healthcare, care you've got four different stakeholders, right? You've got the payer, the provider, the policymaker, um and the patient. And depending on who you're talking to and really who you're talking to within each of those organizations, there's going to be something that that person is really looking for.
00:29:35
Speaker
got So it does not help to like lay out the very detailed plan if that person isn't going to be directly implementing it, right? Like that presentation that I did at the beginning would have been great if I was sitting down with like all the case managers and case manager managers to talk about how we were going to streamline case management. It was not good for the executive office who was having to make a decision about how many case managers are going to need to hire How long should somebody be under case management? you know like What is the process for onboarding, offboarding? like What kind of budgetary allocations should we put? like The presentation was totally not geared towards that. It was geared towards a different audience. so um now what you need Now what I do, what you need to do um is really identify that that audience and then really look at where they're
00:30:23
Speaker
from which angle they're viewing the situation, the problem, um and then tailoring your message, if you would, to really answer the questions that are most pertinent to them. If they're worried about budget, the leading line should be like, this is going to add to the bottom line, or this is going to you know save expenses, or whatever it is. like You want to touch those budgetary things right off the bat, and and then kind of explain it after that, because then you're going to have them looped in. You're going to want them to know that this is pertinent to them.
00:30:52
Speaker
ah I love that lady there's a Japanese term called nimawashi, which is the art of getting buy-in from the different members yeah prior to the meeting. And so just like a yes and, right? So not only think about what those, van like the vantage points and what's going to be important to them, but go ahead and try to get at least some buy-in as much as you can prior, right? Because it's just going to make it that much easier for when you get in the meeting and then it's just kind of a,
00:31:22
Speaker
not quite a formality right because anything can happen and you want to be prepared but if you can make it something and and i I love using this phrase and I wish I remember where I got it from said there's almost no way I made it up ah but turning it from something you have to win to something you just have to not lose yeah like that's those are two very very different things and and so That and in one of those is way more successful than the other in a lot less stress and Yeah, and so by doing what you're talking about, right? You can turn a situation from all man. I got a pitch to win versus I have to pitch to not lose
00:32:04
Speaker
and And because we already have so much momentum going in our favor. Yeah, as much as you can change it from like a binary, um like a binary decision between yes and no to like maybe there are options or maybe there's something like, okay, you want to shift like cognitively or psychologically, you want your audience to start to stop thinking about yes and nos versus, you know, like which option is best or which action should we take? Like, which is the better option? um Because that just it's going to yield one a lot more fruitful discussion, but then it's also going to like decrease the odds of you getting just denied, right? Yeah, just flat no, right? Exactly, yeah. The worst outcome, and it minimizes those chances. Okay, this is...
00:32:49
Speaker
Thank you for listening to this episode. This would not be possible without the sponsorship of Serra Health. Serra is the relationship operating system for physical therapy practices, driving better patient outcomes, improved of arrival rate, and improved financial margins. If you'd like to learn more, check them out at serrasa.com.
00:33:11
Speaker
sarahhealth dot com and If you'd be interested in advertising with us and helping us produce even more great stories, please let us know at stevenatserahealth.com. Now, back to the episode.
00:33:24
Speaker
I want to to shift a little bit sure and go into a a couple of your proudest achievements.
Impactful Patient Interactions
00:33:33
Speaker
I love asking this. so you know One that's within therapy, right within the career, and then one that that's outside. so and Let's start with within the career. and what is What would you say if like, man, I'm darn proud of of that moment, of of that achievement?
00:33:51
Speaker
Yeah, I think, you know, I've been blessed to have just a ah pretty wide ranging career. So I've got like things on the like the clinical side, I still treat it a day a week. And then things like on the business side of things. I think the bet the biggest one from like a personal, like patient relationship thing is when I was leaving the VA,
00:34:10
Speaker
Um, I put my two weeks in and I was on the way out the door and unbeknownst to me, there's, you know, I'm again, I kind of knew like the veterans have their groups and they're meeting about their groups and all that kind of stuff. And they're talking about care at, at this VA versus that VA and that clinic versus this clinic. Um,
00:34:29
Speaker
I'm sitting down, it's like probably my last week, I'm typing notes and my computer like faced a wall. it was so that The door was behind me and there was a knock on the door and I turned around and it was a patient that I had seen maybe you know a year and a half before. It had been a while. He he was not a patient of mine currently.
00:34:48
Speaker
And I was like, hey, man, how's it going? He said, hey, I heard through the grapevine that this is your last week in the VA. And I was like, wow, we're word spreads fast. I said, yeah. I said, there is there's another opportunity. And it just made sense for me to take it.
00:35:01
Speaker
And um he like kind of stopped a little bit, like him hot around a little bit and then said, you know, I don't know if I've ever told you this, um but in our first meeting, when we when we first had an appointment together, um you asked me a question about um what, what i it was basically the Dan Sullivan question, like we're it's three years from now, we're having a beer, we're having coffee and you're happy.
00:35:27
Speaker
um what made you happy And then you kind of dive in from there. um And this guy had, he had some chronic pain issues. He was, um he had like left, he was separated from his wife. He was drinking a good bit. He was estranged from his family.
00:35:45
Speaker
um So he was in there for like chronic shoulder pain or something like that. And we'd like get into this discussion around his drinking and his substance abuse and like his living situation. And I didn't, I felt like I didn't do anything super like novel or amazing. All I really did was I i helped him with his shoulder and then I connected him with other people at the VA, a right? I connected him with a social worker, connecting with a ah counselor for the substance abuse program.
00:36:13
Speaker
Um, and that's all I felt like I really did. In fact, I want to say like, I only saw him five or six times. He did not live close to Augusta. Um, he was as as far as I was concerned, like he, he was doing his exercise at home. He was getting better. And that's kind of what we talked about. I mean, we at at the very beginning, we had talked about like this huge life shift. And I told him like, listen, I'm not really equipped to do this, but I can, I can get you the reason I can connect you with the people that can help you. Right. Um,
00:36:41
Speaker
so Anyways, that's that's this guy. so he's He's back there now. He said, well, you know a year and a half ago when we first met and you we had this ah ah appointment for the shoulder pain and we kind of dove into all my personal stuff.
00:36:54
Speaker
um I don't know if I ever told you this, but you like that that appointment shifted the the course of my life. I just want you to know like I'm going back to church now. I stopped drinking. I've been sober for like 12 months or whatever. I'm still working on stuff with my counselor. ah My wife and I, are you know we're in couples counseling now. and you know It's going to be a long road, but hopefully we're going to be able to mend things together. and He was super, super like talk about like big impact. I was like holy smokes like and he said like you might not even notice this and you might not even been like attempting to do this but just asking the question and taking the time to listen um really gave me hope that there was the possibility for like recovery for normalcy down the line and that's like from a clinical standpoint I mean this is you know what seven years ago I still think about that
00:37:46
Speaker
interaction as like one of the big, big wins. And it's not one that like, no one hears about it. It's not on the website. There's not, I don't get a plaque for it. um But like I made, like just being a good therapist in my mind, they like a good therapist, a caring person, um had this real impact on a patient's life. And even if every single patient, not, you know, obviously not every single patient that you see is going to, you're going to have that kind of, of an impact, but just the fact that it's happened once in my career means that it's possible. you know And that really and really keeps me going some days when it gets hard. It's like, man, we're still we still have the we still have the opportunity to make those kinds of impacts, right? um So on the clinical side, that's that's definitely yeah that interaction with that patient. oh that is a That's an amazing story. That's an amazing story. And you know what?
00:38:38
Speaker
well Frustrating may not be the right word, but a I'm so glad he came back and said that, right? How many stories do you think are out there like that? Who are here? exactly That, gosh, I know we've seen on a smaller scale, right? We've we've seen a couple of really cool interactions of people either you know during care or sending it a really cool message that then the practice owner i can highlight. One of our favorites that I like to use is
00:39:15
Speaker
The patient responded back to how's your pain on a scale of 0 to 10 with 2 because Lucy, you're a genius. And of course it flagged our system because of the non-state of response. And then this was way back in the day when we didn't have as much automation as we we do now. And we ended up sending it to the owners of the clinic.
00:39:35
Speaker
Okay, this is pretty cool. i And then they set it out to everybody, right? if like Holy cow, like this is this is awesome that we even get to recognize this because it probably happens every day all day and it just goes into the ether, right? Or they you know the patient you're talking about is now able to talk to his wife about it. like Gosh, man, if it wasn't for like, I don't know where I'd be right now. like Well, that'd be cool to hear about, right? Yeah, exactly. but It probably does happen a lot. yeah like How many times you've been sitting around with your friends or something like that and somebody's about to go to a doctor's appointment or and they're like, oh, you need to go to this doctor because they're amazing or you need to go to this PT because they helped me with XYZ. I think it happens a lot. We just never hear about it. you know
00:40:23
Speaker
You never do. You never do. And yeah, I think that like, if you could close the loop on that in healthcare, care I think you'd see a, you know, it's not the silver bullet to burnout, right? But I think if you just knew that if you got that positive feedback loop, right? Hey, this worked for me. Thank you.
00:40:44
Speaker
yeah Oh, okay. Well, now today seems better after that. So shifting into, let's take it outside of of of PT, right? I mean, you can be as cheesy as you want to with this or outside therapy. Feel feel free. um We have had people, you know, earlier guests cite their their kids. So, you know, it's always fair play. So yeah, what's your you're outside of PT proudest achievement?
Personal Life and Family
00:41:11
Speaker
Yeah, I would think outside of PT would probably be convincing my wife to marry me because I had no shot in hell. She said, yeah, so 11 years, six kids, and ah it's been a blast. Great ride. Well, congratulations on getting over the decade mark. yeah I'm trailing you on that, but hope to get there here in the next ah here in the next couple of years. and I'm not going to follow you on the six kid journey. I think, you know, we're, we're probably, you know, somewhere between half to a third of that is, is our, is our journey. But I was, I was one of four growing up and it.
00:41:49
Speaker
It was always fun. It was always fun. so It's never never a dull moment at the house, right? No, no. ah Yeah, silence is not a a thing, right? At least ah outside of very minimal parts of of time.
00:42:06
Speaker
So to wrap up, I wanna ask my my favorite question, which is our our our magic wand question.
Vision for Value-Based Healthcare
00:42:15
Speaker
So if if you could weigh the magic wand and one thing gets fixed and in therapy, what would it be and why?
00:42:26
Speaker
Yeah, I think it would be, um I would want to change the focus of the entire industry as it relates to like business models and reimbursement and all that. Like we see it, I see, I don't know if you see it. I see it every time I log in to LinkedIn or Facebook or one of these social media platforms, like somebody complaining about another cut from an, of an insurance, you know, Medicare is cutting 2% or, you know, UHC is only paying X dollars a day or, um,
00:42:55
Speaker
But it's all it's all focused on like this archaic fee-for-service way of monetizing healthcare. care you know like Instead of looking for ways to double down on a broken system, yeah I wrote about this in the book, Better Outcomes a Guy to Humanizing Healthcare. care like There's big problems with the way we pay for healthcare these days in that it incentivizes really crappy, expensive care. um I think if I could like wave a wand, it would just be the shift to everybody's brain from like how do we double down on this broken model and get paid more for it to, okay, how can we innovate in the way that we either deliver, ah sell, or get paid for our services? you know the like The way and the future for PT and OT is really gonna be through leveraging alternative revenue models, whether it be through value-based care, you know remote care, hybrid care in general, as ah just a philosophy of delivering care,
00:43:51
Speaker
But like like I said, it seems that we're willing to die on this hill of fee for service, like getting paid an extra $5 more, an appointment or something like that, um rather than just looking at different ways that we can monetize our expertise and our the value that we really bring to the table as clinicians.
00:44:12
Speaker
And we've been lucky enough through this, this business has taken a quite ah a set of twists and turns over the course of the last seven years. And when when we got started, we found in our nice little niche with these PT groups that were on site at high risk employers, particularly firefighters. yeah And they had these lump sum arrangements where it was really like a managed care contract for that group on a per employee per month. right like It was the classic PEPM model ah for PEPM model. ah and It was cool to see it actually happened to a like strictly a onsite PT group that focused on it. right and
00:44:59
Speaker
And that then created a bunch of incentives where like, okay, could we bring in some athletic trainers to a certain portion of this as clinically appropriate, right? And well, now, if we're just paid a lump sum, well, if we prevent injuries,
00:45:15
Speaker
then we don't have to treat as much and then that's cheaper. Like you can see like the wheels turn. um and And so it came, it just shifted the entire thought process of like, oh, let's not in in kind of like an ironic way, right? Let's not reward the firefighting, but let's reward the person putting in the smoke alarm.
00:45:40
Speaker
Um, and so that's, uh, we, they saw a bunch of success there. And in one of our, one of them in particular, I think they're in like at least 10 or 12 of the biggest apartments in the US. Uh, it makes sense in their whole, their whole idea, which I think back to, you know, making this, uh, making this real for folks was they just thought, okay, we're two pro athletes. We know what it's like to get treated like a pro athlete.
00:46:11
Speaker
Let's try to get as close as we can to treating, as I call them, taxable athletes, like pro athletes. And then let's just see if that the market buys it. And sure enough, it did, right? For all sorts of reasons that I'm sure you can and assume. And i I appreciate what you've done because it even though I'm sure it was a winding road at times, right? Like it looks sequential now and a series of, oh, and then I expanded my boundaries, I expanded my boundaries, I expanded my boundaries and just kept doing that over and over. And even though you it might be a listener might might look at that and say, oh, well, if I look at,
00:46:52
Speaker
He's in that he was in the VA and now you know, he's run his own podcast guys a book like all this stuff like man that seems like a lot it's a big jump, but I appreciate you walking me through your timeline and story because To me it feels like yes to take a lot of hard work. Absolutely to take some risk. Yes, absolutely, right Did it take it on LinkedIn? Yes, whichever one should do it'd be better at but it feels so It feels very like, oh, I could do something similar. And I appreciate how you've made it real to to me. And I hope that others you't feel similarly. And I think the big thing is like, there's no such thing as an overnight success. I mean, very rarely, you know, I've been doing this, what, seven, eight years now. So.
00:47:42
Speaker
I did not start like that. I was like a guy with a Facebook account back in 2016, 2017, when I first started started consulting is, you know, one thing leads to another incremental progress over perfection.
00:47:57
Speaker
For sure. I like that. Progress over perfection. Because if you wait for the perfect opportunity, the perfect time, if you wait, you're going to be waiting a long, long time. Because perfect never comes, right? Exactly. Whether that's career, kids, everything else. Everything, yeah. The perfect time. Yeah, it never comes.
Advice for Innovators
00:48:21
Speaker
so With that, I'd like to give you, you know if if you had one or two pieces of advice for for folks like, hey, if you're thinking about innovating, if you're you know you're you're treating right now and you want to try something new, whether that's outside of your current employer, within your current employer, right just to take that next step to go innovate on something. but what is what are What are two pieces of advice that that you would give to to that person?
00:48:50
Speaker
Yeah, I mean, this might be a little cliche, but it's kind of what I did. I think what you want to do is you want to find like a Venn diagram is ah is the cliche example, but you kind of want to find that intersection between maybe your skill set or your expertise or your passion and then market need because it doesn't make any sense to build something that people don't want, right?
00:49:12
Speaker
um So I would i suggest looking at at your domain area of expertise, if you want to do something clinical or maybe you want to do something non-clinical, what skill set do you have to bring to bear in your chosen marketplace? Maybe it is the PT industry or something like that. Figure out how that expertise or that skill set or that service can provide specific value to the types of clients you want to serve or to work with. um And then just start crafting offers. um pitch a few projects kind of iterate kind of go from there. The first the first patient engagement, like consulting project that I did outside of the VA was for I think she only had one she was about to open up a second clinic. So she was a ah small
00:49:59
Speaker
private practice, PT, <unk>m about to open up per second practice and needed some cash flow issues. And I kind of like pitched her on this whole deal of like, this is what i'm gonna this is what the the idea is. And i was not I did not try to make it sound super, super polished. And part of that is just my personality. Like I ah hate the salesy, markety, like dealing sleazy like a marketer. So I'm very real with people. I was like, hey,
00:50:23
Speaker
I was doing this at the VA. We saw some really good improvements. I'm looking to start some some work in this area with private practices because I think that's where the the lowest hanging fruit is for just ah ROI. And if it's something you're interested in, um it's X number of dollars. And she said, sure. and you know Through that project, I realized, OK, in my process, this worked at the VA. It doesn't work in private practice. This worked here. I probably want to do this a little differently or start somewhere. And I kind of built an entire service offering over on the backs of like three or four clients. And each time I was iterating and each time I was getting better,
00:51:00
Speaker
um getting their feedback and then the price obviously goes up as it gets better. um And I was at the point at the height of this when I was doing the ultimate patient experience blueprint, which was like the thing that I was offering up until a couple years ago.
00:51:14
Speaker
um it had been It was one of those things that was never a solid thing. It was a framework that got iterated on every time. like Every time you're doing something, you're adding to that bank of expertise that you get to bring to the next project. I think that's one of the big problems people have is like they want to do this and they want to do that, or they're doing in this project and that project. and there's no way to like tie them all together. like You want everything you do. It doesn't necessarily need to be a straight line, but you always want to do some kind of project. The next project either should build on what you're currently doing or give you access to more tools and more expertise, more skills that you can bring on to the next project. like You want to be thinking about it like that. like We're developing
00:51:59
Speaker
a bank of expertise here and you know how we get it, how we sell it, what we do might change. But they and the expertise itself, the point of view doesn't change. In fact, it's getting refined every time. And that's kind of what I've tried to do. like Now I'm working with healthcare care technology companies. I'm not doing a whole lot of patient engagement work with private clinics, but I'm using a lot of the insights from that work over seven years to now do work in a different area. I'm just applying it somewhere else. right I liked it a lot and I think you would find it funny now how our onboarding looks in comparison to what it looked like months ago. um But that's part of it, right? like try it ah that did it quite like That part really worked. Like, oh, that was really good. That one didn't. Let's keep iterating and try. I like your Venn diagram, right? you know Finding out what what what you think your superpower is, right? And then market need.
00:52:58
Speaker
And I like that a lot and and I would even push further on the market need is it doesn't have to be a huge market. like Don't yeah look at it and and and think, oh, well,
00:53:10
Speaker
there's only 500 PTs that do this one thing that I'm going to be able to help with. 500 people is a lot of people, right? like That's a heck of a lot of people. And who knows what their treatment style looks like, right? It could be thousands, easily. But don't be scared of small markets, small markets, because they don't exist, in in my opinion, right? You might look at private practice PT and OT, but like, oh, it's a small market, and healthcare care' is $4 trillion. and probably only It's like, it's a lot of money. That's a lot, right? there are I think it's 770,000 PTs, OTs, and if you include assistance as as well in the US, right? like Quite a few. And okay, private practice may only be 450,000 of those. but
00:53:58
Speaker
That's a lot. That's a lot, right? and The reality is if like all the PE firms and the big yeah like Bain, McKinsey, those big groups are focusing on the big chunks. It means there's a lot of little chunks in that market that are not being served and it's it's opportunity.
00:54:15
Speaker
Oh, absolutely. you know In and the venture world, a a question which I abhor and get almost check out. like We can just end this now. If if anyone asks it, you know why wouldn't Google do this so this? Because they don't care about it. Yeah. yeah Because Google doesn't wake up. i They don't get excited about anything that isn't you know at least a billion, if not 20.
00:54:43
Speaker
right I hate that question. Anyway, it's a its it's a tangent. i So to tell you, you kind of read back the advice that that I heard, right? Find your Venn diagram, right? Where it does market need hit with your superpower and create somewhere where you can excel relatively quickly, right? um And then the second, I think it's been a theme throughout their entire conversation today is, you know, you said craft offers, just go try it, right? Go put yourself out there um and and go do that. the
00:55:21
Speaker
I could be speaking for personal experience. The pain of a no is fleeting and can be used as as learning. The pain of regret cannot.
00:55:34
Speaker
And so that's while it might feel worse to get that no immediately subsides pretty darn quickly. Um, unless you've heard it like a hundred times and okay, cool. It's just data at this point. That's, that's it. Um,
00:55:55
Speaker
Rafi, thank you very much. I hope our our listeners ah have gotten as much out, if not more, as I have out of this conversation. I appreciate you taking time away from your businesses, including your practice, to to spend time with us. And I want to say thank you very much for joining the the disruptors. Yeah, thanks for having me. It was fun.
00:56:17
Speaker
Thank you for listening to another episode of The Disruptors. I hope that you were able to take one or two things the away that you can apply immediately to your own innovation journey. As always, I'm your host, Stephen Cohen, sponsored by Sarah Health. Let's keep moving.