Medvale Podcast_Peter LaFleur: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
It's so important that people can get beyond just the pure numbers and sit across the table, look each other directly in their eyes and work together, and I think that the mileage you can get out of that versus, you know, treating an organization or an individual like just another commodity just goes a long way, goes a long way.
Jim Trounson:
Hello, this is Jim Trounson. Medvale is a community of innovative health care leaders. And we have our own podcast, Medvale Radio, where we interview our community members who we call Medvalistas. This podcast celebrates our Medvalistas who are out there making the world a better place to live. Our guest today is one of those innovators, Peter LaFleur is the founder of Consilium Group, which start partners with health care leaders helping them to make better financial strategic decisions. I've worked for Peter for years and have the utmost respect for how his clients trust him. So I invited Peter to join our Medvale community, become a member of our conversation about how to improve healthcare delivery. Peter is now a member of our Medvale healthcare company, Founder's Club, which meets monthly. Consilium is a Seattle-based, Peter has a home and an office in Sun Valley, Idaho, enjoying skiing, fly-fishing, training for triathlons and has a great life up there. So, Peter, welcome to Medvale Radio.
Peter LaFleur:
Thanks, Jim.
Peter LaFleur:
Well, Peter, I might make the observation that you're the most un-CPA-like CPA that I know. That's a compliment. You've got a life. You've got a personality, lots of emotional intelligence.
Peter LaFleur:
I'm a recovering CPA, Jim.
Jim Trounson:
Oh, OK. Well, that explains it then.
Peter LaFleur:
Yeah, no, it's the management consulting side is just such a great profession. It's solving problems and I like to solve problems and it's really a mix of left brain, right brain type things, you know, where you need to get very logical and focus on numbers and those types of things that we can do that as well and go toe to toe with anyone. From that perspective, what I really enjoy is the non-financial side and how do you make it all work.
Jim Trounson:
But you seem to have very long-term relationships with these clients. And how do you do that? Because that's kind of unusual. There's a lot of Joe Smith and associates out there that are doing this, Consilium's different and well, you've got associates for one thing.
Peter LaFleur:
Yeah.
Jim Trounson:
And so, you know, what's your magic sauce?
Peter LaFleur:
There's a lot of the consulting business is very transactional oriented, meaning that we're going to get an engagement and do that project and move on to the next. And our approach has been to get a client, keep it for life.
Jim Trounson:
I'd be curious about the physician compensation work that you do, because that seems to be very topical right now. And can you describe maybe what generically the problem is out there in either a hospital CEO or a medical group lead doc trying to figure out how to pay their physician, which is so contentious? And so what is the problem that you're running into? What's the typical solution that they come up with or other consulting companies come up with? And then what does Consilium do that differentiate you?
Peter LaFleur:
When you hit the nail on the head, the problem to be solved there is that it is a contentious issue and oftentimes it's not handled correctly. And, the implication of that is you have a lot of great providers that leave health systems for the wrong reasons. Well, you know, if I were to go and say, what are the key tenets to a good comp model, I think there's there's probably three. You know, one is you need to have, you need to be consistent and defendable. And you know what that means? That you need a framework. Now, if you look at the continuum here, on one end of the continuum, that can be this very rigid, we see this, there's the organization they go to the MGMA tables, which is a salary survey for physicians, and they say, OK, for a pulmonologist that does this volume of work, you're worth X, and that's this very mechanical thing. And sometimes that's appropriate. But I think there's, there are other things that need to be considered. And of course, most people, when they're told that they fit into this box, they say, oh, that's great, but I'm different. A local markets can be different. You know, I can tell you that a hospital in the middle of Wyoming looking for a orthopedic surgeon has different recruiting needs than a hospital system in L.A. If you're one physician sharing call with maybe one other, that's different than sharing call. I mean, you know, what if I call rotation, it's going to have a very different result on your professional and your personal life. So you do need to take those kind of things into consideration. So that's point number one is it needs to be consistent, defendable, which means that you have to have a framework, that that framework should have some flexibility. Two is that. We need to ensure that it's incentivizing the right outcomes. The reality is incentives do matter. And as much as we like to think that people aren't going to game the system, it happens. But we need to be cognizant of that. But I think more importantly, hitting on your earlier point, it's just that the reimbursement models are changing and know the risk burden in many markets is going more to the providers and less from the insurers. And so having a compensation model that supports that is really important. And that's where we get into these fixed based models within a range. So, again, incentivizing right outcomes is important. And then the third, and this is really the most important, Jim, is that the process needs to be very collaborative and transparent. You can have a phenomenal compensation plan, but if it's delivered in a impersonal memo that goes out to everybody and says on January one, this will be your compensation and there's no input, collaboration, discussion with the providers on that, the message that often gets received is on a commodity. I'm not a valued member of the team and the comp model then becomes dead on arrival. And that's really what's important. And so you asked earlier why, what are we doing different, that, you know, that has allowed us to have these long term relationships and what not. It's we've been able to gain the trust of both sides of the transaction here, the provide, the physicians and the hospitals or the clinic leadership and the physicians, et cetera, whatever the case may be. But the way we do that is that we're completely transparent and we're trying and we're very collaborative.
Jim Trounson:
So these communities that you come into, it seems that you're very interested in the greater good, the health of that county, of that population. So, again, in a very un-CPA kind of way.
Peter LaFleur:
Yeah,
Jim Trounson:
It seems like you're looking at this very globally and then you're not like the Seagull consultants. You stay around and actually administrate a lot of these compensation plans for an indefinite period.
Peter LaFleur:
Yeah.
Jim Trounson:
Which is pretty brave, but you must be pretty confident in your ability to create some long-term relationships with a medical community.
Peter LaFleur:
Yeah, well, you know, and these are coffin-times complex, particularly when you start getting into a lot of the productivity-based compensation models and how that gets administered, et cetera. We have the systems and the process and the people in place to be able to administer. And so to the extent that our clients, you know, right off the bat can't do that, will do it for them, we will teach their people how to do it and transition it to them. We think that back to my point around implementation, it's really key that is done right.
Jim Trounson:
So, Peter, when Concilium goes into a community and gets the results that you're so well known for, what is the effect to the community, to the population health?
Peter LaFleur:
Well, I think, you know, key to the population health is we want to have the best team on the field to deliver that care, right? And too often we see the great team members walking off the field for the wrong reasons. And so if we can help attract and retain great talent, whether it's an individual health system, whether it's within these rural communities, within the community, that's going to drive population health. And the other key to this whole thing is that there has to be a good working relationship. So if you look at a lot of the reimbursement models that are being pushed out now and, you know, as you and I both know, a lot of this is not new. This is rebranding of existing concepts that have been around forever, right? But people need to be able to work together. Until you get people working together and they trust each other, those models, whether you want to call it accountable care organizations or shared risk or whatever you want to call it, it doesn't work if people don't trust each other. People really don't understand or often don't understand that transition costs, turnover costs, because, like you said, it's not just, well we'll spring somebody else in. Well, you've got to bring somebody and you've got to pay for oftentimes recruiters to do that. You need to move them out. You need to build the practice back up. The, whoever's going to pay them, they're paying them a market rate. They're probably going to lose money until that practice gets built up. This is costly. Sometimes it's just the right thing to do. But what we hate to see is great people leaving it for the wrong reason.
Jim Trounson:
Well, I'm intrigued by how many of these assignments turn out to be ongoing for you to stay around to eat your own cookie and administer these agreements that you negotiate and then update them because you've got the trust. What are the compliment to you?
Peter LaFleur:
Yeah, you know, and that typically happens for a couple of reasons. One is these are complex and you do not want to make an error in the implementation. And so, you know, we have the people, the processes and the tools to do it, outsourced basis, if you will, to administer the comp plan. That's one reason a lot of times will train, you know, the hospital staff or the clinic staff to do that. Sometimes we're brought in just to do a check once a year and make sure that from an independent perspective was administered correctly, which provides value to both sides.
Jim Trounson:
Well, going back to the three components of what makes this, these compensation systems work first. One, a framework that's consistent and defendible. Number two, incentivizing the right outcomes. Number three, collaborative and transparent negotiation. So, Peter, as we're coming to the end of this visit, thank you for sharing these ideas on Medvale radio. How could those interested get a hold of you?
Peter LaFleur:
Well, you can certainly go to our website, which is www.consiliumgroupLLC.com, which is spelled C O N S I L I U M group LLC.com. So you can go there, you can email me directly, which is PeterL@ConsiliumGroupLLC.com and happy to talk to anybody.
Jim Trounson:
Well Peter, this has been very thought provoking.
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