Amy Seehafer: COO of Orthopedic & Sports Medicine Specialists (OSMS)

Amy Seehafer, COO of Orthopedic & Sports Medicine Specialists, brings a unique blend of operational leadership and people-first strategy shaped by decades in HR and executive roles across multiple industries. In this episode, she shares how aligning people, processes, and technology is critical to scaling healthcare organizations while improving patient access and experience. Amy also dives into the challenges and opportunities of leading through rapid growth, and how independent practices can deliver high-quality, cost-effective care in today’s evolving healthcare landscape.

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Host: Manish Shukla

‍Guest: Amy Seehafer, COO of OSMS

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Transcript:

Manish Shukla: All right. Welcome back to the Athelas Taking Back Healthcare podcast. Today, we are joined by Amy Seehafer. Thank you so much for being here today.

Amy Seehafer: Well, thank you for having me. I appreciate it.

Manish Shukla: Of course. So obviously, you have kind of like an unorthodox background when it comes to healthcare. I would just love to kind of get a background on how you started out and how you kind of ended up in this position.

Amy Seehafer: Sure. So it kind of goes back to my childhood. I, from a very young age, said I wanted to be a doctor. And I ended up going to college and was pre-med. And I very quickly realized that that MD path just wasn't something that was going to be really a great career for me, despite the fact that I have this practitioner soul. I really thrive on getting to the root cause of things. And with MDs, it's just like I felt like they gave medicines and put bandages on things. And into business, went on to get a master's in business. And then I just worked through my career over the last almost 25 years working in various industries. So I started out working in heavy manufacturing. I then worked in engineering consulting. I then worked in banking for a period of time, industrial distribution, transportation. And along the way, I had met the CEO, who's my now boss at OSMS. And she really just appreciated the skill set that I had and was like, hey, what do you think about joining us? And I was really nervous about it because I hadn't worked in healthcare, but really found that my skills are transferable. It doesn't really matter the industry as long as you have an appetite to learn and really dive in. It doesn't matter where you came from. And I actually find that it's been really helpful not having that healthcare background because I can sometimes see things that other people maybe have become a little bit blind to over time.

Manish Shukla: Yeah, I have to imagine when it comes to healthcare, there's just so much happening at once all the time. There's always a backlog. You kind of end up just being like in, you know, your head stuck in the sand type of thing. But it is saying something that your, you know, current boss saw something in you and said, hey, this actually could work here. So what were those initial conversations like?

Amy Seehafer: Yeah, I think, well, I had been a part of a board through the Chamber of commerce in our community. And I met someone who's the director of marketing at OSMS. And he had said, Hey, Amy, you should really meet my boss. And then he went to his boss and who's not mine and said, Hey, you should meet my friend. So the conversations were really around. If I was going to add a COO to my business, if I'm going to start planning for my succession at some point way in the future? What are the things that we should be looking at? And we spent a lot of time talking about my philosophy around people, process, and technology, because regardless of the industry, it all comes down to those things. The things that power our business are either the people, the processes that we create and follow, and then the technology that we utilize to make all of that happen. We talked a lot about culture. It's a huge thing for OSMS. It's also a really big part of who I am as a human being. And with that HR background, I was able to just really have very fluent conversations about OSMS. And initially I was working for another employer, was very loyal to that assignment and said, hey, no, this isn't going to be something that I'm up for now. And circumstances changed and the opportunity presented itself again. And I was like, hey, I think I'm ready for this. So I joined the team.

Manish Shukla: Awesome. So when you're talking about, you know, your philosophy around people, process, technology, what is the philosophy there?

Amy Seehafer: So I always say it's like it's a three-legged stool. It's, you know, any organization is propped up by having the right people who are properly engaged, doing the right things through process. And you can't, in today's day and age, have processes and people working in your processes without having really great technology solutions. So when you look at the business from these angles, it really encompasses everything that you do and how you do it.

Manish Shukla: Right. So when you were looking at OSMS, you know, some of the in health care typically is slow to adopt technology in general. I'm sure you've seen that. Like what were you what were your initial kind of seeing if we're trying to find root causes to problems? Like what were some of your initial diagnoses?

Amy Seehafer: Yeah. Some of the initial things that I noticed, well, I joined the team and I first just needed to get to know all of it. I needed to get to know all of the words, all of the people who was who. And then really started looking for the shining stars who needed to be developed. So I really focused on developing the team and making sure that the team knew how to lead their team, knew how to establish what process challenges existed, what technology solutions we maybe needed to employ. So I became like a teacher to them to really raise them up in their ability to lead within the organization. But then as far as the company, I looked at the organizational structure and how really how we do business. And I shadowed every single physician. I shadowed all of the front office positions. I shadowed the surgery center, all of it to learn how it all works together and then really started to look for opportunities to smooth things out. I looked for the friction. I looked for the redundancies. I looked for the inefficiencies where people were upset and said, hey, we need to just pick all of those off one at a time and find the solutions.

Manish Shukla: Right. So when you're talking about, you know, finding those shining stars, were those people who were like existing leaders or what were you kind of looking for when you're saying that person is a shining star?

Amy Seehafer: Well, any organization has values and OSMS has very strong values. We also have these 28 culture attributes that really create. Yeah, there's a lot, arguably too many, but we have 28. And when I really think about who is that person who's who just kind of gets it and they're people who show up every day authentically trying to do the best things. They're very well aligned with the culture. They also understand not only the micro portions of the business, so like the things that like the tasks, but they also understand the macro. They understand the strategy. They understand the fact that at the end of all of this, the reason that we're doing this is to make sure that patients have really great experiences and outcomes from our practice. They understand that we are a for-profit business, that we're physician-owned, that we need to serve people from there when you have the right people, you can teach them these skills.

Manish Shukla: Right. So then we pair that and we talk about how, you know, you're shadowing and you're trying to find all these inefficiencies, points of friction. I have to imagine when you're doing that, there is some inertia from folks who go, well, I don't want to change. So when it comes to, hey, we've diagnosed some of these issues, we found some people who we want to help like employ these changes. How do you kind of battle any inertia that may arise?

Amy Seehafer: So that's a tough one. So the good news is I've had a long history of working through organizational change management, right? So I start by doing a stakeholder analysis so that I understand who are all the key players, everybody from the patients to the physicians and the staff and the administration, and then just say, okay, what are we trying to achieve? And from there, we just start to work through the process and say, where do those inefficiencies live? What exists? And then having conversations with people about the fact that just because we used to do something some way, our business has grown. There's one thing that's constant in this world and it's change. So being able to change and move forward is such an important part of any business to be able to get that inertia, to be able to get that flywheel going. So in order to like really get there, we have to all align around where we're going and the fact that change is necessary. And once we do that, everything becomes a lot easier. But there does become this like hand-to-hand combat where I, along with my leaders, need to go in with these people who are maybe established as a resistor or somebody who's slower to adopt change. Maybe they've had bad experiences in the past. Maybe they're a little bit older and technology is just really hard for them. We just take extra time. And we don't just categorize change as a thing that we're going to do. We optimize it to the point where we think about the different groups and how the change is going to impact the various groups. And when we plan it really well, my whole goal is to have people say, oh, that was easy. That was no big deal. Well, then I know that my team and I did a great job because we architected everything to make it easy and make it seem like it was no big deal.

Manish Shukla: Right. Because it's kind of like from the managerial perspective, you're trying to make sure that you're having this experience on the providers or whoever else is taking place operationally so that they can go forward and have that same kind of energy and mood to then kind of make sure the patients have a good experience.

Amy Seehafer: That's culture.

Manish Shukla: Yeah, exactly.

Amy Seehafer: That's culture right there.

Manish Shukla: Yes. Exactly. Exactly. So walk me through maybe some of just the actual operational issues that you did see. Because I'm curious for anyone who may be watching if they can go, oh, that's actually what's happening here right now.

Amy Seehafer: Yeah. Yeah. So there were a bunch. Our business has scaled really rapidly. And we've had to look at everything. So one of the huge things that I heard really loudly when I joined the organization was people can't get through. Nobody answers the phone. Our wait times are so long. So what we ended up doing is, well, my first question to the person who oversaw that area is, how do we measure our success? Well, the answer was, guess what? We don't. And the organization just hadn't created metrics. We hadn't partnered with a tech solution to be able to see. So that's what we did first. We said, okay, what are we trying to achieve? We benchmarked some things. We said, all right, what is the whole time that people will just give up and hang up and call back? And through a whole bunch of different process changes and then that tech solution to be able to see, we have not for like the last between nine and 12 months had an issue with our phones. So that was one.

Manish Shukla: So really quickly there. So it sounds like you're going, OK, this is the issues, wait times. We don't have any observability or tech to measure how this is going. So let's employ tech, like some kind of tech solution to measure. And from there, we can figure out how to actually improve it from there.

Amy Seehafer: Yes.

Manish Shukla: OK.

Amy Seehafer: So some of the others were having, you know, when we looked at the competitive landscape, we're in a geography where we're very heavily saturated with large health systems. So we started to probably fall behind on the patient self-scheduling, on the ability to do the pre-registration before they come in, to be able to do the self-registration at a kiosk or on their mobile phone. So we implemented a software platform for all of those kind of things. We also recognized the fact that we weren't as patient-friendly as we maybe could have been from a payment method standpoint. So made it easier for people to pay their bills because at the end of the day, it's really important for an independent health care practice to be able to gather that money. And we've made improvements to how we do our chart prep. That's a very onerous task. We were making changes to our faxing and incoming faxing. It's just, it was crazy to me when I joined a healthcare organization that everything is still faxed.

Manish Shukla: Yeah.

Amy Seehafer: Well, it's not like the old fax machine that I accidentally called 911 from a few times early in my career. But it's still this internal faxing process.

Manish Shukla: You're calling 911 that often?

Amy Seehafer: I did. I actually, the fire department threatened to give me a fine. And I was like, I'm so sorry because you had to dial 911 to get out.

Manish Shukla: Oh, gosh.

Amy Seehafer: And then when you did like one, nine, two, zero, you know, whatever. And I, you know, being a 23 year old kid just kept doing that. Yeah. So that was something that I did. But, you know, this whole faxing thing, it's amazing. Like when you grow and we're a 40 plus provider organization, you can just imagine with all of those patients and all of those referring health systems and all the things that need to come out and all the things that need to go out. One of the things that we're really looking at is utilizing process automation and AI to be able to do some recognition to be able to route those things. Because currently we're doing it all by hand. We have a person who's like, hey, it caught a fish. Where does it go?

Manish Shukla: Right.

Amy Seehafer: And that just takes a lot of time. And we just don't have the luxury of continuing to add people. So we've been focusing on the technology and the process sides of things.

Manish Shukla: Totally. Going back to your point about like pre-registration intake and all that. I was actually chatting with someone a while ago who, similar to you, where they were an outsider to health care. And they had actually been a general manager at a restaurant. And they started running kind of front office for a health practice. And they said, oh, this is just like table turnover.

Amy Seehafer: It is.

Manish Shukla: So I do think it is nice to have those like different models, but you still have like the same kind of principles. You can just apply them and kind of change them.

Amy Seehafer: Agreed. You know, it's really ironic. I managed a restaurant all through college.

Manish Shukla: There you go.

Amy Seehafer: And I think that really prepared me a lot for it was actually a Perkins restaurant. So it was a lot of, you know, just people who had grievances. And really, at the end of the day, though, what we were trying to do is just delight them with their meal and add some positivity to their life. And it's no different in health care. People are coming in because they have a need. It's not the need to eat, but it's the need to feel better. And that's the one thing that I really enjoy about working in independent health care is that we can serve these people who have these needs and aren't feeling their best and we can help them get back to feeling their best.

Manish Shukla: Absolutely. So going back to some of those issues that you were kind of diagnosing, you know, you talked about observability. Did you find those same, those other areas that you mentioned issues in? Did you also apply observability there or how did you go about kind of tackling and measuring the success of those?

Amy Seehafer: So with those, really what we would do is we would say, OK, we have an issue. How are other people doing this? So the other thing that we really focus on a lot is being members of things like OrthoForum, AAOE. We go to conferences. We meet people. So part of it is you first look at your process and you recognize this doesn't feel right. Okay, well, you need some kind of way to confirm, well, we know it's broken. We just don't really understand what to do to fix it. So we have expanded our network of people in independent practice who are like us and go to them. And we share our knowledge of how things are going for us. And they share their knowledge of how things are going for them. And we just kind of combine our thoughts and say, okay, we're going to try this. But then we also, we meet along the way, we meet technology partners, we research things, we go to conferences and meet people and then just kind of put all of this together and say, okay, we're not going to wait for this to just like align perfectly. We're just going to try some things and keep trying to do it better. So it's not like you just like push a button and you get a diagnosis. You just need to say, hey, this thing doesn't feel quite right. What are other people doing? What is their success or failure been? How could we possibly utilize some of those types of things? And you just try things. We'll just keep moving. Keep raising the bar.

Manish Shukla: Absolutely. Raising the bar is, I think, crucial. So to that point, was this something that already was like a point of culture or a belief at OSMS? Or did you know something that you uniquely brought that kind of paradigm shifted for them?

Amy Seehafer: OSMS has a really strong culture. There's a very strong desire to win. It's a very competitive culture. It's a very prideful culture. And what I think had happened is that the organization had grown so quickly. It had grown fast and probably just maybe too fast. And people started to, when I started, I remember saying it just, it feels like the staff is like sitting in a boat at the bottom of a hill and there's like water coming into it from like a hose at the top of the hill and they're taking a bucket and they're bailing it out every single day so they're they're focusing on these tasks and you know trying to get the water out of their boat so that their boat doesn't sink and they're kind of frantic about it so really what we needed to do is we needed to just level things out and create more peace and headspace to be able to actually look at things and say oh yeah so rather than like getting really close to it like this spacing that out a little bit and saying hmm okay we actually do have some things that we need to get better at because otherwise you just get too close to it and you're just trying to stay alive.

Manish Shukla: yeah you can't see the forest for the trees

Amy Seehafer: yes yes precisely i think your boat analogy is better i've been using the one of you know that episode i love lucy where they're just shoving all the chocolate on the camere belt that's what i've been saying that's that's that's what that chocolate would taste a lot better than that yucky water coming down the hill probably but you know it's just and that's the nature of business and it's not going to stop it's not going to slow down you have to slow it down yeah and I think that's been one of the things I continue to hear from the team that that's been one of the things that I've been able to bring is that kind of calmer harmonizing approach where we can try to keep the the water from like we like clamp the hose at the top. You have to do that. And that analogy is really what we're doing there is we're saying, what are all of the inputs into our process that are causing a problem? What are all of the things that are causing us to have this friction and this bad energy and that are sub-optimizing our business? And then we just solve them one at a time. And cumulatively, they add up to really big things. We don't always just do big things. They're not always huge wins. Sometimes there are a whole bunch of micro wins.

Manish Shukla: Yeah. And I mean, those ultimately add up to what will be a huge shift.

Amy Seehafer: They do. And they help people feel better about coming to work.

Manish Shukla: Have you ever had, so you kind of just like broke down that entire process, right? Have you ever been in a situation where you're just saying this to other leadership or people at the company? And as far as you're concerned, you're like, this is pretty cut and dry. This is very simple. And they're like, that's an incredible point. We never thought about it like that.

Amy Seehafer: All the time. Yeah. All the time.

Manish Shukla: Which has to be surprising.

Amy Seehafer: Yeah. You know, to me, it's probably not surprising as much anymore as I just have realized. You realize at some point in your life and in your career that you have these talents that you were blessed with. And one of mine is being able to look at things that are really complicated and then being able to take them and break them down into terms that people can understand and can work with. And I just feel like that's been my gift. That's been the hand that I've been dealt. So I've gone from organization to organization and have repeatedly done this where I don't get surprised by it as much anymore as I get excited by it because I've seen how you can calm down that chaos and you can just make it all so much easier, better, more fun, more positive energy because to your point earlier, you just create that flywheel of good energy that ends up creating really great outcomes for the patients because that's what matters at the end of the day.

Manish Shukla: Yeah. And so first of all, it sounds like you're like meditation personified. I mean, that you're bringing that calm to folks. But I think if I was one of these, you know, we'll call them shining stars that you identify, I think that's actually really, really special for them because when you're someone who's kind of been, you know, at the more operating, just like the tasks of the general business level, it's so easy to just get bogged in and like, well, this is how it's done. I don't know what else to do. So then to have someone like you come in and paradigm shift and say, Hey, I want you to kind of lead and creating this change. I think that's huge because otherwise you're probably going to just continue business as usual. Last week, for sure. Last week we were chatting with someone who consults with and used to be a CEO of a federally qualified health center. And she was saying one of her major jobs is just telling these leaders, like, you're not just a health center for the poor. Like you can help people of all demographics and you should be appealing to people who, you know, have insurance and can pay more. But sometimes people just get stuck in just how they think.

Amy Seehafer: No, they do. You just get too close to it. And that's one of the things that I've noticed just throughout my career is that you just have to, I'll say, hey, let's go up to 30,000 feet. Let's just take a breath. Let's look at it and say, you know, if you were a patient, is this what you would want to experience? Right? Question number one, are we hitting the mark? Because we like to say that we're different. We like to say, choose independent healthcare. Of course, we don't say this exactly like on a billboard, right? But our claim to fame is really that we do it better. We do it different. So my challenge to my team has been, okay, well, let's just not just say that, but let's actually personify that. So what would you want? How would you want to feel? And it's been really powerful. We just got through annual review season, and I could not be more proud of my team. The growth that I've seen in the last year in people just not only being able to see things, but they also find the courage to be able to work on things and not only just work on things, but they work on them together. And they don't just start, but they finish. And they finish after because it's like waves coming over the side of the boat, right? They're coming in like you're trying to deploy a tech solution in a company of our size. And it's hard and they don't give up and they just keep going. And my goal at every job that I've ever had is to eventually work myself out of a job. I want to elevate those people enough so that they don't really need me anymore. It's kind of like as a parent, as a parent of kids who are now, you know, in college or near college. That's been my goal all along is to just figure out how do I create that independence. And it's it's just so fun. I have so much fun with it every single day.

Manish Shukla: That's awesome. Something that I do find unique is that you said we really want to win. I feel like that's something I usually hear with like startups or sales teams. I've never heard that before with a health practice, like literally not even once. So like what, where does that come from? And how did, what does winning look like to you guys?

Amy Seehafer: Yeah, I think, you know, when I think about how an independent practice is situated in the market like us, we're saturated in the Fox Cities, Wisconsin location with all of these large health systems. So we all know what's happened to health care around us in the last decade or two. And it's become really difficult for independent practices to continue to exist. And then you also think about how orthopedic surgeons and ortho doctors are built. They are built. These are competitive people. Or they wouldn't have chosen the fields. They're very mentally tough. They're people who have a lot of clarity, a lot of drive. And you put all of that together. And it's been an organization that has kind of adopted those qualities. And I also feel like my boss, who has been, she just had her 25th anniversary. Her name is Sandy. And she, Sandy, I wrote Sandy an email the other day that just said, I feel like your mark is on like every wall and everything. And Sandy is an incredibly competitive human. And I think you marry all of that together with the external circumstances, the players on the team, and then the ultimate leader who has been with the business for 25 years and just continually like, go, go, go. We got this. And just continuing to think at other angles and create new playbooks. And it's just become the persona of the organization. And my goal is to have that just become a part of the playbook of every player on the team, which is hard because we're now over 400 employees. So it becomes infinitely more difficult as you grow to have everybody thinking through those lenses and listening through those filters and making their actions the way that they should be in order for us to win. But there's something fun about that to try to say, okay, how can we capture as many of these things in alignment as possible? And that's what keeps me going as a leader is to try to just keep aligning it and keep educating and keep teaching and giving feedback and all of that.

Manish Shukla: And that's where those like little tiny ones still really matter.

Amy Seehafer: They do. They do because they're very personal to people. People don't show up to work every day just to exist. They don't show up to create friction. They don't show up to do non-value added work. People inherently want to be valued. They have ego, not in an icky way. They seek relevance. They want to win. Everybody in their own way wants to win. And having those small wins and taking the time to celebrate those wins, it just creates more momentum. And not only the wins, but also the losses. We win together and we lose together. That's another thing that we talk about a lot as a team. We don't always do everything perfect. We sometimes have things that don't go great and we have to step back and say, okay, how do we win? Well, people get energy from that too. And they feel like they have the trust of the leadership to say, shoot, this one didn't go quite as planned. We just recently had a circumstance where as part of our pre-registration and self-check-in and all of that, there's this call center component with a wait list that allows you to be able to automate your wait list and fill these empty slots that unfortunately persist in our practices. And that call center setup just wasn't great. So maybe a year ago, the team wouldn't have sat back and said, oh, you know, what can we do to fix this? But they've learned and they've grown to the point where they were like, oh, this isn't feeling right. They pushed pause. They came together. They consulted, went back to the technology partner and said, these things are deal breakers to our business. We need you to partner with us to make these things better or we're at risk of no longer partnering. and I'm just so proud of them that they've found their voice and also have found the power in not just like freaking out going down this like spiral of like right actually just saying hey this isn't feeling right what do we do about it and then holding our partners accountable

Manish Shukla: right so you you are slowly working yourself out of a job it sounds like it sounds like it sounds like you're doing it

Amy Seehafer: that's my goal that's my goal always and it's uh it hasn't done me wrong

Manish Shukla: Right. Also, Sandy sounds kind of like Tom Brady. It's like you've been this competitive and you've been winning for how long? Seven rings?

Amy Seehafer: That's a really long time. Yeah, 25 years is a really long time. And, you know, she's still a relatively young woman. It's been half of her life she's been at this. And it really is inspirational for her to just continue to dig deep and, you know, keep figuring out how to how to beat all of this in independent health care.

Manish Shukla: Definitely. So you folks are at 400 now. When you started, how many were you at?

Amy Seehafer: That's a really good question. I think maybe 300. I think we've maybe grown by about 25%. We added about 25% in physicians. We've added to all of our groups. We've added competencies. We added a spine competency. We've added to our rheumatology group. We've also added to our ortho and our pain groups.

Manish Shukla: So as you were kind of diagnosing some of these growing pains and actually, you know, finding the root cause, applying solutions, how did you balance growth with, you know, solving those problems? Because you also don't want it to be like a Jenga tower, right?

Amy Seehafer: Yeah, it's really hard. You've captured kind of the art of a job like mine is to try to continually figure out how to do more with less, but not to topple the tower. I say this all the time. And it's really hard because we also rely on our external markets and those forces, whether it's the current economy, because when the economy is uncertain, people don't necessarily seek elective health care. And many times we're elective health care. So you have to have the revenue coming in. Just because you hire a provider doesn't mean that you can just hire a whole staff to staff their clinic. But there's a bottom to the level of labor that you can apply to that clinic for them to be successful. Like you don't want the physician going to the waiting room and calling the patient's name and taking their blood pressure. We want them to have that staff so that they can optimize the amount of time that they're providing surgical procedures and actually working in their specialties.

Manish Shukla: So as you are, you know, fixing some of these growing pains, adding new providers, something I'm curious about, especially when it comes to, you know, how ridiculously manual a lot of these existing health care practices, processes can be, is there's so much burnout among providers. So how did you go about helping quell that and kind of reversing it? Because it is hard to be like, I know I'm burnt out, but I have to keep going.

Amy Seehafer: That's something that we continue to wrestle with. I will say I feel pretty blessed that I work with a whole bunch of health care athletes. These are people who bring it. They dig deep. They don't in general complain. However, I'm very aware and my team is very aware of the burnout factor that you highlighted because they have to be on all the time. They are in that patient room. They have to be giving 110%. And then they go from here. They run to our ambulatory surgery center upstairs. They're running to the hospital to do the tougher cases. They're trying to eat something in between, trying to make sure that they maintain their body and their soul and their health and their family and all of that. And day in, day out, year in, year out, that becomes a grind. So from And my perspective, it really becomes important for us to figure out where is that undue administrative burden that keeps them from spending their time on the things that they should, whether it's in our clinics and surgery centers, hospitals, or at home with their family and with themselves or their faith or whatever it is, their hobbies. And the more we can take out that exhaustion factor that's unnecessary and have other people do that work, have technology solutions or processes in place to be able to take that out of the physician's mind space or physical space, we're winning. That's the goal. Because I can't change the patients. I can't control their moods. I can't control how complex their health situations are. But what I can do is make sure that they are exposed to as minimal of that other stuff that's going to cause them to burn out faster.

Manish Shukla: Right, right. Does that make sense? Yeah. You can be like, you don't have to do it this way. Which, to your point, like applying technology solutions there. I mean, you mentioned a few things earlier. But what are some of those technology solutions that you've already found have been working?

Amy Seehafer: Yeah, well, we adopted that software that I was telling you for the pre-registration and the self-check-in and the call center and all of that. That's really been helping us. We also have an after-hours triage support that we use a technology solution for. We're also, I would say we're not using it enough. We have a real opportunity in the ambient AI space. but these solutions including the one that athelis currently has we're talking with athelis about that because we don't love the solution that we have we found that there's limited adoption it's kind of clunky in the physician's mind so what do they do they just stop using it and if we're going to have a technology solution and we're going to pay for a technology solution i want to make sure that that solution has a good roi and the first step is actually using it and having it decrease the time rather than increasing the time. So that's one that we're currently wrestling with now. We continue to look for opportunities to automate processes. I mentioned the faxing and the faxing solution so we don't have to have a person just saying, hey, you know, caught this fish, got this fax, which bucket does it go in? That's just so 1995 to me. It's like, how in the world are we still doing this? At the root of it all, though, is you have this employee medical record, employee health record, practice management, EHR, EMR, PM solution. That is like the engine. And we're on a relatively old platform. We're on GE Centricity. That was purchased by Athena. Yes. So we are on Athena practice. Yes. And one of the things that we're finding is that you can only do so much. You know, if you have a 2001 Buick that you're driving around and you're like, it doesn't have Apple play. Right. Yeah. Yeah. There's only so much, you know, that car still drives, but is it really working for you? Is it keeping you safe? Is it, you know, what is the miles per gallon?

Manish Shukla: It's like when someone gets in your car, you're like, it doesn't, the windows don't roll down all the way.

Amy Seehafer: And you can't go back in the seat. No, exactly. Yeah, that stopped working last year. But so that is a project that we're working on right now is to figure out what could be a next step there. So we're starting to vet solutions because there's only so much you can do from a feature standpoint and bolt-on standpoint, if your core engine of your business is, it's old, you know, that technology and how the new technology works, you need really, really nimble two-way communication. Well, we don't have that. So we find ways to work around it for now, but that's the next big thing that's going to be up for us. The other thing that we're looking at is like an automated AI voice attendant. That's something that we've done a lot of disruption with all of the new patient intake and things like that. People just take a while. We have a lot of older patients. We don't want to overwhelm them. So I can see at some point on the horizon, we'll likely do something in that AI phone space as well.

Manish Shukla: And it's for like inbound calls?

Amy Seehafer: Yes, for inbound. And it can actually make outbound calls as well for reminder calls and things like that because it becomes harder and harder to find people who every day want to answer the phone over and over and over again. That's a job that can be a real burnout and it's hard to find people who want to do that every day.

Manish Shukla: Definitely. So to the point of the existing Ambien solution that providers have been using, they're saying it's clunky. You're looking for ROI. For starters, how are you measuring ROI on your end?

Amy Seehafer: Yeah. From my standpoint, I don't have a really detailed equation for ROI. I would say it's more of a subjective than objective at this point, but I probably should, hearing you ask it that way, I should probably have some better criteria. So I'll take that as a takeaway. But from my standpoint is if the bar is at, do the physicians like using the software? Is it usable? And does it actually save them time? Can we create some repeatability in the process so that they don't have to start from scratch every single time. Because we realize that how we dictate actually determines how well we get paid for these claims, right? Because we don't set our prices. We have contracts, and those contracts are based on how well we dictate things to meet certain criteria so that we can optimize the amount of money that we're being paid. So that's the other aspect that I'd be looking at.

Manish Shukla: Because then from a charge capital perspective, sometimes there's issues with undercoding and not actually being able to maximize what is actually billable from that encounter.

Amy Seehafer: Yes, for sure. And many times the physicians, whether they're new physicians or physicians that are well-practiced, they don't know. And these things get trickier and trickier. And the insurance companies are using AI solutions to scrub the claims. So we need to combat that by utilizing technology solutions to create it in a way that the scrubber isn't going to scrub out the dollars.

Manish Shukla: Yeah. Yeah. And then to the point of it being clunky, I'm curious, like, how is it clunky for them? What don't they like about it?

Amy Seehafer: It's more so they don't like the fact that it will make errors. It'll call a male a female. It'll call a female a male. It will capture things in the ambient conversation that don't need to be in the note. It'll capture things sometimes from a person in the room rather than just the patient. It will put things in the wrong box. You know, like when in your EHR system, you have very specific boxes that you put very specific things in to, again, submit to the employee record and then submit to the insurance company. And it'll just create things. So then the doctor has to go through and read all of it again and move things around or re-dictate things.

Manish Shukla: That's not good. Right. It ends up being like the Tasmanian devil instead of actually helping you.

Amy Seehafer: However, I would acknowledge the fact that I think we have a real opportunity to, as we're looking at this whole process, to not just say, how can the technology solution work for us? But we also need to work for it. So I have found that the physicians in all of the shadowing that I did. The physicians who have the best outcomes with the AI dictation software are the ones who have made small tweaks to how they interact with the patient, which some physicians just don't love. So it's going to be really cool to see the technology continue to evolve in the way that physician can have their natural style and yet continue to be able to put things in the right boxes. So at the end of the day, what we're trying to do is not that complicated, but it's humans. And in order for the AI to weed through that humanness and be able to put it in these very defined boxes, I think is where the magic happens. So I'm looking forward to learning more and more about the Othellus solution. We're underway with some conversations with that right now.

Manish Shukla: Amazing. Yeah. Cause really what it should be is to the point of like ROI and it's not putting things in the right boxes, this person's male, like it should be able to like, cause people call that hallucination sometimes, which really that is like an old issue with, you know, this AI LLM technology. That's like a solved problem. And so it's really a matter of just like, okay, let's get that information right. But then two, it's like, there will be a slight workflow change on the provider's part, but really it should be hyper-customized to the provider. Because really what you can do is you can just convert intent, like, hey, I need to make this note and then have like a repeatable, you know, outcome every time of just like, I know exactly the format this note needs to be. Like, and for ROI for you, from the COO perspective, I was talking to this one provider. She said what used to be two hours at the end of her day, every day has now turned into four minutes.

Amy Seehafer: Yeah.

Manish Shukla: She's like, that's what we're going for.

Amy Seehafer: Yeah.

Manish Shukla: She's like, now I can play with my kids.

Amy Seehafer: Yes. Yes, for sure. Because that goes back to that burnout factor. These are tough jobs. they are on all the time. They're, you know, like surgeons are performing really difficult procedures that are, you know, they're high risk. And I want to make sure that they're at the best that they possibly can be. So all of this just, it comes together in little pieces of it. I'm really excited to hear more about the software and what it can do. I would hate to be getting surgery for a torn ACL and I'm being operated on by a burned out.

Manish Shukla: Yeah. Right. I know. I know. We do forget. We expect providers to be like 100 percent perfect all their people. They're people.

Amy Seehafer: And that's one of the things that I think I it was this really aha moment for me in health care that you see these people as almost like superheroes. Right. Like we all grow up watching like movies and comics and things like this about like superheroes and Disney movies and Hugh Laurie house MD, he's a genius.

Manish Shukla: Yeah, exactly.

Amy Seehafer: And you start to see the difficult sides to it that like these are really highly functioning human beings at the end of the day. So how do we create and augment all of these things that happen around them to be able to help them just be their best?

Manish Shukla: Yeah. And that's really fun. Yeah. Have you seen the new Scrubs reboot?

Amy Seehafer: No.

Manish Shukla: Did you watch Scrubs?

Amy Seehafer: No. I'm not a huge TV person. I'm just not. I've been working and raising a family. I'm just not. He'll come back.

Manish Shukla: There's a very famous buddy duo in the show. In the reboot, one of them, he is a surgeon. His friend is back in town. I think the other series ended with him leaving. He's back in town. He's like, hey, everyone's calling you Dr. Bummer now. What's going on there? Then he's going, I'm burned out. Nothing's fun anymore. Now you're bumming me out. I wanted to have fun. That's such a, like, as a viewer, it's a bummer to see because you're like, oh, I remember these. It's sobering, isn't it?

Amy Seehafer: Yeah. It's too real. Yeah. And as, you know, our society, it's been interesting with, like, social media and online reviews and all those things. People have a platform where they just, they can come in, like, in one swipe, like, just take these swipes at people. And they, you know, a lot of times they take out their aggression on their health care providers because we say you're going to maybe be your worst with people who you trust. Well, our people trust us and they come in and they want us to help and they take it out. And when you add up all of those cumulative aspects of these physicians, it's truly a miracle that they continue to perform at the high caliber that they are. And I just view my team and myself, we're just ultimately responsible for caring for all of it to create this environment to make it all a lot easier and make it possible to have that stuff. Because, again, at the end of the day, we exist to serve our patients and get them back to their best because they hurt. Their lives are suboptimized. And it's just really cool to be able to create this ecosystem where people can come in, feel so much better, and just get back to their lives.

Manish Shukla: So there's something I'm curious about your thoughts on. We take the culture of OSMS. We want to win. We take your being an outsider and being able to apply those changes within OSMS. But then you look at how the end-to-end revenue cycle works. What were your thoughts on that as an outsider? Like really seeing kind of under the hood how that's handled.

Amy Seehafer: Oh, it's been a huge wake-up call because it had never really occurred to me before that health care providers don't decide what they charge for something. In what other industry, other than commodities-based businesses, would you find a situation where those prices were set for you? It largely stems from what the government chooses to set as the Medicare rate. And then all of those contracts are set. That set point is there plus something. And how hard we have to work to consistently get less and less dollars. And then you pair that with the fact that labor is more and more expensive. People are more and more burnt out. They're not showing up at 100%. COVID really changed the way that people handle everything and what the expectations are. These aren't work from home positions. These aren't, you know, positions where you can come in half yourself. You have to show up. The other thing that's really just baffles me is the acrobatics that go on around compliance and how you actually get paid and how you get your money and then how long it can take people to pay you your money. Like the accounts receivable over 90 and when I look at that number in any other industry that I worked in, that would be exponentially higher than anything we would ever say is okay.

Manish Shukla: You take the business model to Shark Tank, they'll say, get out of here. This makes no sense.

Amy Seehafer: They will. Yes, for sure. But we're in it. This is our world and we exist to serve the people. So it becomes, we have to learn how to play the game. Those payers are playing the game with us. So we have to learn how to play the game back. But it just keeps getting more and more complicated and just harder and harder to make money. And yeah, it had never occurred to me that it was this difficult and that we don't have any say in what we get paid. We also don't have any say in how much things cost us from a materials standpoint, a supply standpoint, utilities, labor, all of the overhead. Those are dictated by the markets. So somehow to take out that magic wand and figure it all out to just keep reinventing ourselves to beat the pressure. And it's an immense pressure.

Manish Shukla: Right. Because you already have all these hoops you have to jump through from beginning, even before a visit starts, all the way to, I don't know, doing any reconciliation for accounting down the line once you've gotten the money in your bank. And then you pair that with, oh, we're getting under or our reimbursements have been lowered now for all of these codes. And then, oh, on top of that, they're now just auto denying with AI. Like the deck is so stacked against providers and practices.

Amy Seehafer: Yeah. And what we're seeing now is that it's like, OK, well, now you need to do this. You need to submit this thing through, you know, like UHC just recently made some changes with imaging and with prior authorizations and referrals. And like, then what we have to do is do these gymnastics internally to say, how are we going to have our processes and our technology solutions and our people yield the things that are actually going to allow us to get paid? Because in many cases, these changes happen so fast. And you also have to have a net out in the water to be catching all of those. because it's not like there's like, you know, a station that's like, hey, you know, broadcast, this is happening. You have to partner yourself with people who are out there trolling for all of that to figure out what's going on so that you know what's going on so that you can not be behind the eight ball. You have to be ahead of it and making all of these changes so that you can continue to get paid at the level that you deserve to be paid. Right. And it just never stops. It's analogies around like fishing and you know like things like that because I try to like make it seem more palatable to people on the teams because it almost like you almost have to like gamify what it is. Otherwise it's too bleak. It is right because and that's the other part on the tech side I am I'm really hopeful that as we move forward throughout the next several years at OSMS that not only on the operational side like in the clinics we'll be looking at the technology but I really, I work a lot with my peer, who's the director of revenue cycle management, and really being able to look at technology solutions too, because as we grow, we become more complex. We have more claims going through, you know, again, you just have this repeated work that become, you have to ask yourself, do we continue to grow our teams and have more labor doing jobs that are just really not palatable? Or do we augment our team and just kind of cap out that staffing model and maybe even shrink it over time with attrition as people find other opportunities. But you have this technology solution that really helps to propel you through that space. It can learn and it can actually do all of this and automate the processes. I really do believe that that is something that is going to be a part of our future. We've had a lot of conversations with one of your team members here at Athelas and haven't pulled the plug or haven't pulled the trigger on that. But we're really excited about being able to look at that in the future too. Because it's really hard. It's a grind and it's just ever changing. It's like, how do you cast a net that's wide enough to catch all of that? And yeah, it's kind of like, you know, I was just having a conversation with one of my coworkers the other day and we were talking about taxes. And it's like, when you're really simple and you're just a single person and you don't have a really complex life, you can do your own taxes with TurboTax. But you become an owner of a business. You have a family. You own properties. You have Swiss bank accounts. Well, I don't have any of this, by the way.

Manish Shukla: Not yet.

Amy Seehafer: No, not yet.

Manish Shukla: Once you're out of a job, you'll have a Swiss bank account.

Amy Seehafer: Yeah, right, right, exactly. Well, I won't count on it, but maybe. But you have to hire somebody to do it. You have to up your game on the technology side because you become too complicated. And really, that's part of growing a business. It's kind of that Achilles heel, and it's the reality of growing a business. As you grow a business, you become more complex. And then it just becomes infinitely more difficult to keep that thing on the rails.

Manish Shukla: Yeah. Even when I do my own taxes on TurboTax and they're like, do you have this deduction?

Amy Seehafer: I'm like, I don't know.

Manish Shukla: I have to imagine that occasionally happens on the revenue cycle side where you're like, I don't know what that modifier means.

Amy Seehafer: If only in real life there was a maybe button or an I don't know, right? Yeah. Because there's that whole joke. We'll keep working on it.

Manish Shukla: The IRS is like, we know exactly how much you owe, but we're not going to tell you.

Amy Seehafer: We're going to make it a mystery. we're going to make you try to get as close to that as possible, but we're not going to pay you that if you don't find those little nuts out there, squirrel. Payers are very much like, we'll pay you what we want to pay. They are, right? Yeah. And again, based on, you had asked me a little bit ago, I was very naive to that walking into this healthcare situation and it's been really fun to learn all of it. And if anything, it just gives me energy to just try to figure out how to continue to beat it? How do we continue to rise above it and win this game? Because I happen to be an incredibly competitive person too.

Manish Shukla: As you should be. Yes. So when you are looking at some of these issues within revenue cycle, what are the most important metrics that you're looking at to measure success there?

Amy Seehafer: Well, I would say we're getting into a space that is not my specialty. So I probably am not able to speak to that in quite as much detail as I've been speaking to some of these other things, but it's really important for us to first and foremost be having the claims be as robust as possible. So it's a garbage in garbage out thing, right? If we don't get things into the system appropriately, we're not going to be able to submit them. Also timeliness, right? So we need to have our physicians finishing their charting and closing those cases, signing off on them so that we can actually build them. Once we build them, we also have to be figuring out how are we going to handle denials? How are we going to handle things that just aren't moving anywhere that we have to go through these acrobatics? Well, you have to do all of that stuff. How long is it taking for us to collect our money? How much money are we actually getting versus what we thought we were going to be getting? Analytics around how could we possibly be coding things differently, using alternative codes and combinations of codes to be able to optimize the amount that we're being reimbursed. Those are some examples that I can think of.

Manish Shukla: Yeah. To your point, observability, analytics, knowing trends. Sometimes I've heard providers go like, we didn't know that trend existed. Now we're rethinking our relationship with that payer. Maybe we shouldn't have this contract.

Amy Seehafer: Well, and the other thing too that I'm starting to focus on, and I'm struggling a bit with our current technology solutions. Our ERP is kind of an older smaller product our emr is a you know an aged product really what i'm trying to look for is like from provider to provider too like who are the people who have a higher batting average right those are the people that i want to understand what are they doing differently and again there's no rhyme or reason to this sometimes you could have physicians who have been physicians for 25 plus years and sometimes they're not doing as well they have really great patient outcomes, their patients love them, but they're maybe not getting paid as well. Well, how do we, or they're not pumping through as many patients or like whatever it is. So I'm always looking for kind of at that macro level, but then also breaking it down to the micro level and then learning from best practices and saying, hey, this is somebody who's continually winning. What are they doing that somebody else isn't doing? And that's a tough game because we've got, again, we've got 40 plus providers, but it's been fun to unpack all of that.

Manish Shukla: Selfish plug on our end. That is something that is really nice is that with our revenue cycle, you get everyone who also uses it and you can also do that kind of sharing.

Amy Seehafer: I've seen it.

Manish Shukla: Oh, really? Okay, cool.

Amy Seehafer: Yeah, I have. The person that we've worked with has been really great. She's shown us that. It's just something that we haven't been able to get there as an organization yet to really realize that a technology solution is the best play. But I know that will come. It's just, you know, sometimes you just have to get your house in order a little bit before you're ready to make that big plunge.

Manish Shukla: Absolutely. So just to kind of round it out here, it's been an absolute pleasure kind of chatting with you. I'm curious if you have any advice for, you know, the folks looking to get into this space, as you did. What would you say are kind of the perks that they can kind of look forward to?

Amy Seehafer: Well, I will say anybody who's looking to work in health care, you have to be a person who really likes to learn. It's highly complex. It's highly technical. You also have to be really resilient because it's amazing. It just keeps coming for you, right? I mean, on any given day, it's just you cannot make up the things that come up. It's kind of like working in a restaurant, right? You just are being a bartender. Or the I Love Lucy chocolates.

Manish Shukla: Yes, yes, exactly.

Amy Seehafer: It just keeps coming for you. And you have to be hungry for those challenges. And you have to have that winning mentality where you can just back away from it, look at it and say, all right, who are we working with? What are we putting into the system? What is the system? Is that system sufficient? Like, what are we yielding? Are we yielding what we intended to be yielding? and are people, whether it's internally or externally, are the people happy? So you have to be able to be patient enough to look at it and be objective enough to look at it to say, what are all of these components so that you don't have this garbage in, garbage out thing, so that you can actually point optimize and look at all of these sub-processes. You have to really have a drive to understand the detail. And you have to be okay with minutia. You have to be okay with a challenge. There's just a lot to it. Got to be tough, I would say. And I think all of the industries that I've worked in and all of the great people that I've been able to work with along the way have just shown me that, along with probably just how I'm built.

Manish Shukla: Right. Even just hearing you explain all that, I saw you getting more fired up as you were talking about it.

Amy Seehafer: I get really excited about all of this. I do. I just, you know, I'm a leader of people, first and foremost. I love setting things in order, decreasing friction, creating harmony. I love seeing people be their best selves. I love seeing people have positive energy. And that's what drives me. And I get excited about it every single day. You can ask anybody who works for me or with me. It's just how I am.

Manish Shukla: Amy Seehafer. leader of people, COO of OSMS. Thanks so much for being here today.

Amy Seehafer: All right. Thanks for having me.

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