How To Increase Reimbursement By Contracting Directly To Employers With Ryan Klepps Of Second Door Health

[00:00:00] When you go self-insured, you are completely in control of your visibility into your claims data and you could actually make changes to your benefit package, right?

[00:00:09] To do a number of things provide better benefits so that you can differentiate and get more at better acquisition and retention of your employees.

[00:00:19] You might want to put in programs that reduce your overall health care spend or provide wellness opportunities for employees.

[00:00:30] Welcome, you've entered the Physical Therapy Owners Club podcast where your host, Nathan Shields and other successful PT owners and leaders share their experience and insights on how to build successful PT businesses.

[00:00:43] They'll share the stories of their paths to success and show you how you can also obtain greater freedom and more profits from your business.

[00:00:50] That's what the PT owners club is all about. Greater freedom and more profits.

[00:00:55] There's plenty of room for you as well so come on in and join the club.

[00:01:04] Hello and welcome to the Private Practice Owners Club. This is Nathan Shields and I've got a guest who's going to bring up a topic today that I'm really excited about because it's something that we've been hearing about at recent private practice series conferences for the APTA and that is the direct to employer model.

[00:01:24] So Ryan claps the co-founder and CXO of second door health is joining me today. Ryan thanks for joining me and explaining to us a little bit about this opportunity that's before us.

[00:01:37] Yeah, yeah, thank you Nathan and Justin Moore at the APTA is actually an advisor of ours so we've more closely with him on all things direct to employer.

[00:01:45] That's cool. Yeah, so people who are listening to this that phrase simply direct to employer might be new to them.

[00:01:52] Even if it's not can you just give us a breakdown you're an expert in the industry. Tell us a little bit about what direct to employer means as it relates to physical therapy owners or even OT or speech therapy owners that might want to delve into that space.

[00:02:05] Yeah, yeah, I think to start it's why would you want to go direct to employer right and what the opportunity is.

[00:02:11] So yeah, what do we mean by direct to employer direct to employer is effectively rather than just going through traditional third party reimbursement you are going out to a local or regional employer and you are contracting directly with them.

[00:02:30] We'll talk about the who like what types of employer should you target to provide streamlined access into conservative care to deliver more of a PT first model that gets better outcomes and reduces costs right so what we do really, really well.

[00:02:44] We've been shouting from the rooftops for a long time.

[00:02:46] That foundationally is direct to employer where you're actually your foundationally changing the health plan benefit package out an employer to incentivize conservative first care provide preventative services and really look at things from a population health perspective versus see patient treat patient.

[00:03:06] So these local and regional employers they'll use a third party like an etna or signal or blue cross with shield as the benefits path care benefits package for their employees right.

[00:03:19] And you're saying, hey I can save you money I can or this is a better benefit to the employees if we just carve them out carve the physical therapy portion out and work directly together is that what we're talking about.

[00:03:35] Yeah, there's a lot of different ways to do it. I think let's talk about the who right so the primary target are employers that are self insured not fully insured so the distinction is nuanced meaning if you're an employee of a business you don't know whether or not that business is fully insured or self insured but the opportunities are very different.

[00:03:56] So in a fully insured model and employer just says I pick blue cross blue shield right, which means they get the shelf blue cross blue shield plan with the shelf blue cross blue shield provider network.

[00:04:09] The employer has to pay part of the premium to blue cross blue shields and blue cross is both the administrative layer meaning they're going to take care of all the claims and they're the bank account they pay out the claims right so the difference is when you go self insured.

[00:04:27] You still work with a traditional insurance company, but they are a TPA, a third party administrator. So again if the insurance company traditionally is the administrative layer in the bank account when you go self insured.

[00:04:41] The blue crosses of the world are now just the administrative layer and you as the business are the bank account you're the at risk entity right so that means like all the claims that are sort of paid out impact you right like you have to pay them out so rather than just your premiums going up if you don't run away healthcare costs it could cripple your business right so number one or the number two costs for every business after salaries is healthcare.

[00:05:06] And for self insured businesses it's a real problem but the beauty is the reason why people go self insured is there's a good not having access to their claims data and understanding where their spend is coming from.

[00:05:18] And they just get a notification from blue cross at the end of the year when you're fully insured and it says your premiums are going up 15% don't ask why we don't have to tell you if you're getting about it.

[00:05:29] So when you go self insured you are completely in control of your visibility into your claims data and you could actually make changes to your benefit package right to do a number of things provide better benefits so that you can differentiate and get more.

[00:05:44] better acquisition and retention of your employees you might want to put in programs that reduce your overall healthcare spend or provide wellness opportunities for employees right so there are many reasons why employers are looking to make benefit level changes.

[00:06:00] Really talking with the employer and understanding where their paying point is helps you then come in and position what is a potential solution for that.

[00:06:09] These employers these companies are they typically a certain size at which this model works better for them and obviously these are the types you're going to target but I'm just thinking of my mind what kind of company could I envision would be self insured model.

[00:06:24] So 65% of US workers are covered by self insured plan. Yep, there's about I think those latest numbers 150,000 self insured businesses in the United States. There's a lot of them and traditionally self insurance only made sense for the really big guys.

[00:06:41] Folks that were over 2,000,000 employees right okay and over the last five years that is shifted because of the rising cost and just the challenges of doing business right self insured.

[00:06:54] Just a math equation makes more and more sense down market so about 60% of employers if they're 200 employees to 1000 employees are self insured and it's over 80% if you have more than 1000 employees and over 90% if you have more than 5,000 employees right.

[00:07:11] You see that's increasing because of drastic.

[00:07:15] The highest rate of folks going into a self insured model are in the small 30% of employers that have 50 or more employees are 50 to 200 are not self insured.

[00:07:28] That was not even close to that so now it's even making more sense on the small small end and what we're not talking about our entities that you might not think about I mean they are employers but municipalities school districts union.

[00:07:41] Right all of those are almost ubiquitously self insured so local police and fire a local school district your city government all of those are in a self insured plan where they can make the changes they want to their benefits.

[00:07:57] So those hyper local opportunities are huge for PT practices.

[00:08:02] And do you find that they are open to these conversations with private practice owners who are especially do they already understand or this are they searching out looking for opportunities like someone to come to them and work directly with their employees.

[00:08:19] So it's not a always yes what I'll say is okay market is on a maturity arc where more and more folks are aware they have a problem and want to solve it.

[00:08:31] And this market's been really maturing for a while over the last 5 to 10 15 year trade where I don't know are you familiar with the bigger like the digital MSK's pain shelf sort health.

[00:08:43] I've heard of sword but these are well funded organizations that are doing mostly this is especially on the virtual end right.

[00:08:52] Yeah, yeah, these are.

[00:08:53] And so the change in sword have both independently raised about a billion dollars of peace right so these are silicon valley.

[00:09:01] Businesses likely to go public right and foundationally what they do is or what they did their models changing a little bit but they recognize that self insured employers had a problem so they built a technology solution.

[00:09:17] Higher to a bunch of physical therapists another hiring health coaches and really rehab providers and they went to self insured employers.

[00:09:25] They started with the very large ones and they said you have a healthcare cost problem and the employers said yes you have an MSK cost problem in SK is.

[00:09:34] The number a top three cost for every employer regardless of industry and it's the number one spend bucket for like 75% to employers right so they really quickly.

[00:09:46] When you say MSK that's mostly will scale told but these are not workers compensation claims these are strictly outside of worker compensation claims just someone spraying their ankle or hurt their back.

[00:09:56] Not on the job but they're getting care for that right that's not workers' constitution.

[00:10:02] That's where the biggest opportunity is on the group outside on average 75% of the cost comes from regular claims 25% comes from workers come so people need workers comp solutions but let's be honest like if somebody needs a work comp solution PT is best position to service it you should go and you should win that deal.

[00:10:19] But what's happened on the work comp side is what's happened on the payers side right which is it used to pay really well and now.

[00:10:27] It's starting to get commoditized and these large networks own most of the deals and they're sending them to the people who are willing to get paid the least so we're seeing the rates of reimbursement drive down.

[00:10:37] And they're inherently lies the problem right that the practice doesn't have the leverage they don't have the control they don't have the contract typically it's going through a network so either have to take a case at a certain rates or not take it at all.

[00:10:52] There are opportunities to contract directly with an employer on work comp I think a lot of troops have done that but no the vast majority of the opportunities on the group outside because that's where the cost is for the employer and whether looking for solutions right.

[00:11:07] And what hinge and sword in these digital MSKs have done is they validated you have a healthcare problem you have an MSK cost problem.

[00:11:14] And then they said well I have a solution for you it is early in consistent access and to conservative care because if you start with conservative care like physical therapy your cost is going to be reduced by on average 60% right this is all data we know right like every PPS conference.

[00:11:30] We've been screaming this from the rooftop for a while and we've been trying to negotiate with payers to say we get better outcomes out reduced cost.

[00:11:37] And we've been selling the wrong thing to the payers because they make more money by healthcare cost going up in premiums rising right so we've just been selling the value props to the wrong stakeholder.

[00:11:49] What hinge and sword have gotten right is they've gone to the people who actually care about quality and cost right being able to weigh yes the employer should and they say look we can put this model in.

[00:12:01] It's conservative care first we're going to reduce your surgeries for an overdue syrup needs we're going to reduce high cost pharmaceuticals and advanced imaging because people are going to get PC first and they're not going to need that stuff.

[00:12:12] And like they've done a great job selling they built a massive sales organization it news is is I don't know they sold like three or four thousand employers and I just told you there's 125 thousand self critical players in the US.

[00:12:27] Yeah and they traditionally sold to really big employers which means the local municipalities and school districts like those are still really green field opportunities.

[00:12:37] But we're starting to see them looking at these types of solutions and what's been really encouraging is while the value prop is landing the digital MS case are able to sell.

[00:12:49] They struggle with driving the return on investment because they can't get more than 3% of people annually to use the thing because consumers don't want digital only.

[00:13:02] PT right when you say digital only mean like virtual visits yeah so their technology is mostly more and more self service right they've got a lot of like algorithms and AI that are going to drive like when should a PT go tap in right but like.

[00:13:17] They are doing a handful of actual virtual visits and then it's a lot of like self service self progressing back pain programs and like right.

[00:13:29] So it is a different spin on PT and they're starting to layer things in like mental health stress management lifestyle modification all that good stuff.

[00:13:42] Hey everybody we finally did it. Finally we're doing our first in person event and private practice honors club first ever in person conference September 20th and 21st in Clearwater Beach for the.

[00:13:53] At a minute our super side really can't wait to finally meet you in person this entire time of increasing reach out step out network and I can now provide that to not just virtually or via podcasts but in person speakers that speak on leadership and growth.

[00:14:08] We'll answer questions to your current issues provide you opportunity to network like my personal like my name and which was obviously gain inspiration and energy for being in the room with the same people.

[00:14:18] You'll be able to literally reach out this step out and network all in one weekend is September 20th and 21st at the high at Clearwater Beach for the I would really love to see you there in order to register go to ppoclub events dot com pp oh club events dot com and registered to sign up for the event.

[00:14:36] Also early bird registration ends July 31st so to get a discount on the registration fees make sure you sign up get your room between now and July 31st otherwise prices will go up.

[00:14:48] So go to ppoclub events dot com thank you to all of you who are listening for so many years I would love to find a new person.

[00:15:11] If someone who has a niche that is pelvic floor or pediatrics or like you said mental health maybe there's a social worker that has their own practice or maybe there's a PT that has social work as part of their practice.

[00:15:27] Are those additional benefits that these same employers are looking for?

[00:15:32] Yes, yeah I mean you can go look at it.

[00:15:35] I'll not to keep harbour on the hinges in the source but they've just launched their pre and postpartum programs right and advanced strengthening programs.

[00:15:44] I actually just met with a PT practice owner in Arizona who has built his entire practice on direct to employer and he employees a primary care doctor and a mental health specialist.

[00:16:01] So provide comprehensive services to local police and fire that is not just PT right because he's not selling PT he is selling a better benefits reduction in MSK cost and streamline access into the right level of care with a lot of preventative services layered on top where.

[00:16:20] When somebody is done with academy they come in and he's assessing how they're putting on their gear and talking about like.

[00:16:29] He's adding a lot of value outside of just if you're hurt you're coming into PT right now.

[00:16:35] What practices are able to do is one negotiate directly with the employer a better rate typically than what you would get from third party reimbursement which we know just keeps going down.

[00:16:46] They remain they own that contract right so nobody can come in and cut it by 15% and if they have the sophistication.

[00:16:57] They can prove out MSK cost savings and they can increase the value of the contract right significantly where it can become a real revenue driver and looking if we we all know the problems the industry is facing related to reimbursement if it keeps going the way that it's going.

[00:17:14] We're going to continue to have massive provider shortages and I think I don't know how practices around a profitable business today on pure reimbursement and it's not going to change unless we change it and but we've already shown that going to the payers isn't going to do it so.

[00:17:29] If you can get me in full volume through a direct to employer contract or a handful of contracts prove out the value that makes it easier to sell more and drive a better net rate and.

[00:17:41] Truly work with groups that have aligned incentives right where like they are looking for better access and lower cost you can provide it you just gotta go deliver right.

[00:17:52] Yeah, so I'm wondering about those who are listening who might be the single practitioner clinic or maybe they've got a singular location with maybe two or three providers whatever that.

[00:18:03] Healthcare services that they're providing and they don't have an MD on staff or social worker are they behind the ball simply because there are singular location and maybe a little bit smaller do they have any leverage to go in pursue contracts like this or do you need to be a certain size.

[00:18:21] In terms of number of facilities covering a certain demographics or geography if you will of space so that it's more attractive to these employers.

[00:18:31] Yes, and no that group that I talked about started off with two PT's and they've scaled into the model they have today because they were successful initially with just he and his business partner right.

[00:18:41] And they're not interested in the one location.

[00:18:43] They still only have one location and they go on site right also they will go on site to provide services or just assessments services and assessments.

[00:18:51] Okay, so they can provide that on site as well as in their own facilities okay yep and what else is like yeah it's going to be really difficult for a single practice to go win.

[00:19:02] It's 10,000 employee group that has regional offices all over the country like as people want uniform benefits right they don't want just to do something in one office.

[00:19:13] So the way I look at it is you have to understand where your fit to win if you're a single location group most of.

[00:19:20] At least in fire in your town right in your town most teachers living your town most small businesses are the owners live in your town right and that's where you can go focus and.

[00:19:34] That's where we're seeing the one or two location groups really win but there also may be some little large manufacturing you know like I grew up in Bristol Connecticut right.

[00:19:44] Yes, PN for some reason is there right and you're not limited in that capacity what you can try to do is.

[00:19:51] Moon more on onsite services as opposed to triage into a brick and mortar facility and yeah groups with many locations definitely have the upper hand but the fact of the matter is.

[00:20:01] The group has 70 locations are they really going to go target your local municipality maybe at some point but I think every pt group is fit to win.

[00:20:12] And so we have certain people.

[00:20:13] As long as they know their limitations and keep it appropriately targeted towards those that they can work with how open are these municipalities to negotiating like this and more specifically.

[00:20:26] Well, are they open number two who would you talk to who do you even start with?

[00:20:29] Yeah, they are open we're talking to a number of school districts right now as our a lot of the customers that we're working with we know pt practice this we have school district police fire.

[00:20:40] And we have a customer that has an entire county as a contract right so and that's the other thing is like.

[00:21:06] There's value to be delivered it's just about going ahead and delivering on that value.

[00:21:12] And then what was that second part of your question I think I missed.

[00:21:15] Yeah, if you're talking about a go.

[00:21:16] Yeah, so the agency who would you approach?

[00:21:19] Yes, there's a title a common title that you're looking for.

[00:21:22] Yes, so unlike the work comp side and this is an important distinction if you're selling work comp versus a group health benefit and as came management solution.

[00:21:34] Is two different doors with two different stakeholders so a common mistake that groups make is they say I have a work comp relationship.

[00:21:42] So I'm going to go talk to the head of safety and pitch this broader.

[00:21:46] Mmm, program.

[00:21:47] In fact, in the matter as the head of safety almost falls over because you say early consistent access into pt and what the head of safety cares about is reducing reportable claims and keeping people out of health care right.

[00:21:59] We don't want more visits.

[00:22:01] Exactly exactly so it's not going to resonate with them and that's very commonly where the pain point and challenges is the who you're selling to is different and it takes practice a while to figure that out who you're selling to is.

[00:22:14] The person in charge of benefits right this morning HR probably had people VP of total rewards VP of HR director benefits benefits analysts like.

[00:22:25] I got you.

[00:22:27] Yeah, that's your primary stakeholder and so to put some real numbers behind it if someone's averaging ninety dollars of visit on reimbursement say.

[00:22:36] Could they realistically be seeing significantly more than that or what are some of the numbers you're seeing on average per cent.

[00:22:43] I mean, well into the hundreds right over a hundred dollars is what I'm seeing per visit I've seen contracts at a hundred and fifty dollars an hour.

[00:22:52] I've seen capitated case rates negotiated at.

[00:22:56] 1500 dollars a case and that's really nice because then you just got to get people better faster and you can talk the difference you do play technology and say we're going to do some virtual stuff and only see people for six times in person right here.

[00:23:07] You're control more of your destiny right so it's not just about revenue per visit you can go flip and really think about delivery mechanisms and how to get more profitable and and deliver on value.

[00:23:17] And where I've seen the most upside is customers who say.

[00:23:24] I want to analyze your MSK cost before we start this in afterwards and if we prove if we show MSK cost reduction healthcare cost reduction.

[00:23:33] I want to share of savings rolled into my contract from there on out right where it's okay we reduce healthcare cost by 15 or 20%.

[00:23:42] So we're going to take half of that that's going to roll into a monthly fee and now you're just getting paid for what you treat and the services you provide but then just the value you're providing so.

[00:23:53] There are a lot of different pricing models like we could spend an entire time talking about how to pack edge in price this I think the short of it is if you talk to the folks who've been doing this for a while there's a reason why they continue to do it and we need harder and harder into it because not only is the payment better.

[00:24:11] But often contracts are negotiated at no copay no deductible no need for authorization no visit caps right it is a reduction in administrative burden where somebody can just come in and be seen because you're illustrated into the employer that you're not just going to juice visits right if you just do that you're not going to get the results of reducing MSK cost so.

[00:24:36] That's again the alignment of incentives is really nice here so you can roll a lot of those things in which one if somebody has no copay no deductible if they see you but it hits their copay and deductible if they go out into their standard plan.

[00:24:51] You're going to drive more people into your practice which is a good thing and then a higher rate of reimbursement reduce admin burden it's sort of a trifecta when when when.

[00:25:00] Yeah talking about when when that was what I was thinking might have there's a benefit for every player in this scenario and you just alluded to it and that is the employee.

[00:25:12] If you're negotiating something in which they don't have a copay or co-intransfer deductible if they come and see you.

[00:25:17] That's a benefit number one if you're on site and then you can work with them during their business hours and they don't have to come in after business hours or take work off and get a babysitter to come and see for physical therapy.

[00:25:28] Huge win no one wants to do all that crap to go to physical therapy honestly right huge win save the employer some money on their healthcare costs right whether that's MSK mental health you name it anything.

[00:25:41] And then for you yeah added revenue increased revenue per visit especially if you break it down in any different way but to especially get a percentage of the financial benefits of providing that service for the company huge win fall right.

[00:25:58] So a lot of great opportunities there.

[00:26:02] From a bigger picture why hasn't the industry been doing more of this more vigorously.

[00:26:08] I think the last five years have pushed the industry to a bit of a breaking point right post co-vid cost have gone up by about 10 or 11 percent really over the last five years.

[00:26:23] Reimbursedment on average has gone down by 1 percent and we have never been reimbursed a ton but we've always found a way to make it work we always found a way to be profitable and we're just seeing that inflection point where.

[00:26:36] I mean united for a long time has not been a profitable payer but like the cost of doing business now is still razor thin that we must do something so some practices are leaning into cash pay services but there's only a certain market for that people have to have high net worth they have to not necessarily.

[00:26:51] I think we're going to be really wanting to go within their house plan and stomach high cost but there's a place for direct consumer for sure.

[00:26:57] But we've been paying our heads against the brick wall for 10 15 years.

[00:27:01] More going to payers and trying to sell value and it hasn't worked right so.

[00:27:05] I think people haven't been doing it very vigorously in the past because they didn't need to but I think they need to now.

[00:27:12] Another thing yes, the need I get it well tell us how do people have I'm sure they've got a 10 more questions like how do you approach this what do you say how do you negotiate.

[00:27:23] Tell us a little bit about second or health and where you guys come in.

[00:27:27] Yeah, so myself and one of our founders are CEO Scott this is our second run at building software solutions for the physical therapy industry.

[00:27:39] We built a company called Stride Labs that built the first patient relationship management marketing automation platform for physical therapy ended up being used by about a third of the industry.

[00:27:50] We were acquired by we're a 20 17 and we're at we're a little while well, well, well four or five years before we moved off and started this venture.

[00:28:00] So everything we've talked about is because we really feel like the impetus is now in PT is at a critical point so we built a software platform that helps to sort of administer it direct to employer contracts and to end because there's a lot of pain points when you have multiple contracts.

[00:28:17] How do you keep your service lines lined out if you're invoicing an employer directly your EMR billing system isn't set up to do that.

[00:28:25] How do you drive enrollment from employees and put enrollment marketing plans and to play and collect the data where you could show the employer that you're reducing cost and getting better outcomes right there can be a lot of overhead I think to start there doesn't have to be that much get a contract figured out every practice that is done this and done it successfully.

[00:28:45] Rob Wurf who's one of the folks who is doing a lot of the direct to employer stuff at PPS I'll paraphrase him but he's like yeah, I stumbled and failed my way into success right now he's being modest right.

[00:28:57] He's done a lot of right things along the way but he's just gotten out and went and did it right so and figured out a lot of these like solutions how do I go do a lot of these things right.

[00:29:08] But out of the box we want to make it really really simple to administer these contracts for practices both direct to employer but also direct to consumer and then with our early customers we are providing.

[00:29:20] A ton of professional services to help them go out and win contracts in their area.

[00:29:27] Okay, like training them on what to say and who to talk to and how to approach them and what those people want to hear so that your presentation falls appropriately so on them.

[00:29:38] Yeah I'm wearing the t-shirt I'm wearing the morph physical therapy t-shirt and I'm reading the sales pitch.

[00:29:44] Yeah you're coming in as part of the team and help them negotiate right.

[00:29:47] Yep, ourself and myself and our head of provider partnerships Jake Neuro that's basically our full-time job is how do you prospect in your area what is your sales pitch what is your deck and then over time folks feel much more comfortable.

[00:30:01] leading the process themselves but we're getting in and pitching and then I mean business business sales is different and difficult you're going to fail far more often than you succeed in business business sales.

[00:30:13] But it's about the process and optimizing that process so that you could learn and then scale we've been doing business business sales Jake and I collectively for.

[00:30:24] 25 years right each of us like 12 or 13 years a piece so we at least know the mechanics of how to build a B to be sales award what we lack is the local connectivity.

[00:30:35] Right just where your unique value is most practice owners I talked to one who said me and my partners were born here and we're all going to die here right and like while that's grim it's that's meaningful that means you know people.

[00:30:52] Yeah you know the hierarchy probably it means that you know folks who have moved and prominent positions at employers in your area that leverage is what can get you in the door.

[00:31:01] But then what right that's where we want to come in and help we won't do that forever right now we feel like it's important to get the wheels spinning we want to just give people the.

[00:31:11] Hey here's what you need to do without sitting on a weekly meeting with Jake and I but that's sort of what we're doing at second door.

[00:31:17] So I'll just say I'll say for you if you're listening to this podcast in 2024 2025 then that might be an option that they could leverage and that is you helping them do that if you were talking to 2026 maybe maybe not right.

[00:31:30] Our hope is that by 2026 we have it so locked in that you sign up and you enroll and direct to employer academy and we can just guide you through how to do the stuff and give you a lot of the collateral that you need to be awesome.

[00:31:46] Yeah, well and last question for me and then I also I want to well let's do this first.

[00:31:52] How do people get a hold you Ryan at second door health dot com you can just email me.

[00:31:57] Okay, and you have website that they can also look into second door dot app.

[00:32:04] Second door dot app okay are you on any social media's not today yeah we're okay well as a business I think we have a LinkedIn I swore off social media about eight years ago so you won't find me on there good for you will find me on LinkedIn yeah.

[00:32:19] Okay, no else yeah I got you so lastly how much time doesn't owner need to set aside for something like this I'm assuming an owner that's treating full time is going to have a hard time adding this to their play.

[00:32:34] What do they need maybe like five eight hours a week at least to get it started but then be capable of taking on more hours if they want you on site.

[00:32:43] Yeah, I mean look going out and getting contracts is the hardest thing like I'm not going to sugar code it it's difficult because you're starting out from scratch and.

[00:32:53] You likely don't know what you do and right so you want to get as many reps as possible to be able to own and sharpen that but what I'll say is if you really thought full about.

[00:33:01] Mapping out your network who do you know you can get many at bats pretty quickly and it's not just who do like what businesses do I know to where my neighbors have my sons on a soccer team who am I close with like that's in my.

[00:33:15] Working at work right yeah and that network I'm telling you when you go the warm route you will get a meeting so much faster and more often than if you're just.

[00:33:25] Trying to get into the local school district and you know yeah but from a time spent standpoint I think you're going to have to spend the most time on the front ends making sure that you've got.

[00:33:37] The sales collateral your pitch deck you're really sharp in terms of what you're offering and then from there if you're leveraging your network to get quick wins and meetings.

[00:33:47] You go focus in on where you have the leverage and you're probably putting in four or five hours a week if you're focusing in on five opportunities and any given time.

[00:33:57] And then of course as that starts progressing and you get closer to having a contract in place you then have to think about how do I operationalize that.

[00:34:05] And if you're just a solo practice owner the only person right like that's probably time where you make sure that your contract is worth enough where you can bring somebody on.

[00:34:16] Yeah because you have another side of the business that needs to keep running and you don't want to break and look we have folks who.

[00:34:35] And you're in a way that works for where you're at operationally.

[00:34:40] But yeah I mean there are some practices that are not that large that have gone completely out of network don't really even see public they just focus on their five or six employer contracts that they have it's their business so it can go to 100% of your time.

[00:34:55] Yeah it could be almost none if you just go and contract a couple of small employers and put it out of power.

[00:35:03] Nice I mean it really is something that's going to challenge those people who are complaining about the decline in reimbursements while you can either just sit and complain or you can maybe create new opportunities right.

[00:35:16] So you got to pursue some other avenues like you said a we're at a point we're at a junction point like you said this flexion point where.

[00:35:24] We've got to do something different and if it's a number of opportunities you can take advantage of we've talked plenty about going out of network and whatnot for those lower pairs but.

[00:35:33] This is just another opportunity to improve reimbursements that we are wanting.

[00:35:37] Yeah and look out of network I think we should go out of network with the people who are greetiously reimbursing us.

[00:35:44] But going completely out of network takes you even further away from the leverage points right because you can't go renegotiate right with a pair but if you have an employee like what I see happening in this industry over the coming years is.

[00:36:00] If enough practices can get employer contracts and they could show reductions in MSK spend.

[00:36:06] And employers demand these types of solutions the TPAs are going to make these a standard offering and bake the payment models and alike into their offerings and that will change the reimbursement.

[00:36:21] Climate completely right and it facilitates a true.

[00:36:26] He is the primary care for MSK that's the model we're implementing right so if we do a really good job of it.

[00:36:34] We can bring the pairs to the water or some to drink a little bit and actually see a much more sustainably growing industry.

[00:36:43] Very cool well hey man thanks for all of the explanations thanks for your time.

[00:36:48] Highly encourage people reach out to you especially to see what you can provide them and thanks for your work with the industry I think this is great.

[00:36:57] Nick and I appreciate it thank you for your work in the industry too man it's been a pleasure getting the chat with you.

[00:37:02] Alright thank you.

[00:37:05] Thanks for joining us today in the physical therapy owners club the resource for stability and freedom in your PT practice.

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