How Behavioral Health Systems Scale (And Where They Break)

Ashley Kent (00:01): Welcome to our actual very first episode of Growth DX. I'm Ashley Kent, founder and CEO of ClearStart, and today I am joined by Dr. Adisa Shirley

Ashley Kent (00:13): Who is the current Chief Growth Strategy Officer at Clinic Mind, but has quite an expansive background as she has dipped her hand into quite a few different areas within behavioral health as a PE operator, clinician, and is now sitting in the growth officer seat in a technology platform. So we're super honored to have her

Ashley Kent (00:36): join us here on Growth DX. And looking forward to our conversation today.

Dr. Edisa Shirley (00:41): Thank you, Ashley. I really appreciate you. I appreciate you having me here as a first guest. I am absolutely honored and yeah, I'm excited about this conversation.

Ashley Kent (00:51): Well, tell me a little bit more about your background. I kind of touched on it a little bit. you have a pretty unique background, and it's something that's incredibly valuable within the healthcare space. But you know, bring us all up to speed a little bit on, you know, the journey of what has taken you to where you are today.

Dr. Edisa Shirley (01:09): Yes, as you mentioned, I'm a chief growth strategy officer clinic mind. For anyone that is wondering what that is, we're a practice management platform. So EHR revenue cycle credentialing AI tools, and we're serving behavioral health and chiropractic practices across the country. my path, as you mentioned, is a little bit unusual because I did start on the clinical side. I'm a licensed mental health therapist.

Dr. Edisa Shirley (01:34): And then I spent most of my career in operations, operating for P groups, and also the MA side of behavioral health. I was at refreshmental health, which became a part of Optimum behavioral care. It was one of the largest acquisitions in behavioral health space. And it did not happen, it w it wasn't that long ago. if we think about it, it was six years ago, I think something like that. I was leading post

Dr. Edisa Shirley (02:02): In acquisition integration at national scale. Then I ran operations for P-backed, become behavioral partners, doing acquisitions and operational turnarounds across multiple states. So I've kind of lived like at every seat at the table. So I'm clinician, operator, integrator. Now I'm on a technology side.

Dr. Edisa Shirley (02:24): And also I have my own advisory firm where I do advisory work with investors. I do diligence, integrations. So I really get to see the whole behavioral health landscape from all different angles. and I I quite I kind of enjoy it. I enjoy having all those perspectives. so it really allows me to fully immerse myself into the field and truly understand what's happening, like from the top, you know, where the

Dr. Edisa Shirley (02:51): Money starts flowing to all the way to the bottom of you know patient outcomes.

Ashley Kent (02:56): That's incredibly interesting and you know, mm it's not very often that you have basically you've expanded across the three different areas that you know healthcare can cover from actually being a practicing clinician to going into the money side of, scale and operations within a P-backed, platform and then all the way into technology, who has been selling into these as well. So you have this really cool 360 view into everything you've been doing, which is incredibly valuable.

Ashley Kent (03:24): I wanna take us back to your experience on the platform and operator side as you were going into these acquisitions and applying what you knew from the clinician side and taking a practice at scale. a lot of these practices, you know, as you go from a handful of locations to 20, 50, 100 plus, whatever it may be. I'm curious from your perspective, what are those things that you found that

Ashley Kent (03:52): maybe are specific to behavioral health that start to break. And then what are those kind of milestones within are there certain milestones in size and scale that you see different breakpoints within there that people just underestimate as you start to grow in scale and can tend to forget that maybe they should be thinking about that they're not.

Dr. Edisa Shirley (04:10): Yeah. you know, what's what's really interesting is that it's almost never the clinical side that breaks, right? the clinicians are really for the most part doing really, really good work. And where it really breaks is the administrative plumbing, I would say, underneath that. and it breaks quietly.

Dr. Edisa Shirley (04:32): which is really what makes it dangerous. So it's not that this is this one boom where you realize, my gosh, this is totally not going where it's supposed to go. first, credentialing that usually breaks first. it's a silent killer of behavioral health growth in general. You hire a clinician, you're they're on a payroll, but they are not enrolled with the payers yet. So you're paying a salary with a zero revenue coming in at

Dr. Edisa Shirley (05:00): You know, at three locations, that's you know, it's a headache, right? At 30 locations across multiple states, with every payer having its own timeline, that backlog compounds, and suddenly you have months of revenue trapped in enrollment queues. So that is, I would say that is like a danger or flag number one. the second that usually breaks is RCM billing.

Dr. Edisa Shirley (05:30): so the billing workflows that worked fine when, you know, when it was just a founder and his wife, and you know, they could look over everybody's shoulder, that starts leaking. So inconsistent documentation, front desk processes that were never really designed to scale, but worked, right? Like i I don't know if you ever read a book, What What Got You Here Won't Get You There. I always love to refer to that book because

Dr. Edisa Shirley (05:57): It's really not that it was wrong what got you there, but it won't take you further. And I think this is very interesting for you know for me to explain it to some of the founders that you did a wonderful job with what you had to get it to here. But as you start scale, some of these processes they're not designed to scale with you. They're not going to get you anywhere. you know, I

Dr. Edisa Shirley (06:25): I saw that firsthand at many of the acquisitions that I worked on. you know, where, you know, one of the one of the acquisitions I work on was my biggest, you know, turnaround was exactly that, you know, where you know, I go in, clean the credentialing backlog, and then stop that billing leakage that happens sometimes because of credentialing, sometimes because of processes and you know and workflow. So it's not a glamorous work.

Dr. Edisa Shirley (06:53): But it's usually where the margin kind of lives. So you know, people often ask me, like, well, you know, when you go in, what do you do? Well, those are the first things I always look at first. Yeah. and then, you know, in the third part, I think it's worth mentioning is the integration work. When you're acquiring practices, every one of them arrives with its own unique challenges, different EHRs, different fee schedules, different culture.

Dr. Edisa Shirley (07:22): And most platforms budget for the deal, but they do not budget for the operational lift that comes after that. Like even the first 90 day, and then what happens in a day 91, right? What happens like right after that? So you know, the way I put it usually to founders is, you know, deals don't fail at signing, they fail months or you know, month four.

Dr. Edisa Shirley (07:49): I would say usually month four of integration where the infrastructure can't really absorb what you just bought.

Ashley Kent (07:56): 100% and you know, and that's such the value prop, right? That you're selling to clinicians, these are the parts that they don't wanna manage anymore, and that's why they're

Dr. Edisa Shirley (08:03): Mm.

Ashley Kent (08:03): selling their practice in the first place. and that's where, you know, as you're looking at the operations on the platform side, having a path and plan to scalability within there is so critical, but it can be the thing that is almost like you said, it hits day ninety one and people are like, Well, we didn't

Dr. Edisa Shirley (08:18): Mm-hmm.

Ashley Kent (08:19): think about that, we didn't plan for it. and that's something that I've seen on my side as well too, with multi-sites is you know

Ashley Kent (08:24): There's a usually a breaking point where you can be scrappy up to a certain point. And it's almost, you know, it's as few as 10 practices, honestly. And it's there's all these decisions that maybe hadn't been made because they were trying to move quickly and they maybe started getting traction with the clinics. And then, you know, post 10, I mean, especially if you're getting into 20, you know, if you do not have that repeatable playbook every single time when it comes to the operations, even marketing, even you know, all of those different things, it can break down really quickly because at the end of

Ashley Kent (08:54): Of

Ashley Kent (08:54): the day, like that's what they're selling, you know, for

Dr. Edisa Shirley (08:57): Mm-hmm.

Ashley Kent (08:57): is for you to take that off and you to be that leader and that to guide them and what it may be. but it's not easy and it even you can have the playbook of all playbooks, and you know, as you said, every single practice has its own unique set of challenges, and whether it's the people, whether it's the systems, whether it's processes, and how do you start to go from where they are exactly like you said, to where they need to be to be able to operate at scale. I'm curious what what's the breaking point you've seen?

Ashley Kent (09:23): Where being scrappy and nimble no longer works and you really need to have a more repeatable process as you start to acquire more clinics.

Dr. Edisa Shirley (09:31): yeah, and I think something you mentioned, you know, being scrappy. I think you're supposed to be scrappy. I don't want like I you know, scrappiness, and I know you're a founder yourself. Early stages of every business are supposed to be scrappy. And I think it's good to be scrappy. so I don't want to like, you know, sometimes like founders, you know, feel like

Dr. Edisa Shirley (09:56): You know, when you have those conversations that they did not do good enough or that wasn't good, it it it really is, you know, it it it was good. You're supposed to you don't have this team. You don't have five million dollars to invest in to build out this big C level team. And now you no, you you're one person. You are billing manager, credentialing manager, you know, you are front office person, sometimes you're even a clinician and

Dr. Edisa Shirley (10:24): it really starts I see it like between like two, three million dollars of revenue to like ten million dollars of revenue. where I seen practices where they are too big for the scrappiness, but not big enough to afford, let's say, a huge team behind them. Right? Because it does take a team and you have to get your business as a founder, you know, as a and as a

Dr. Edisa Shirley (10:53): you know, clinician, often clinician, behavioral health. When I say clinician founder, I would say ninety-eight percent of the time the founders are psychiatrists. And you know, it's getting it, you know, over that hunch of, okay, I need to really get, you know, more resources in. And here really the key is the infrastructure, investing into the infrastructure.

Dr. Edisa Shirley (11:20): that will set you up for scaling. And that's what I think where some founders are they find themselves in a, well, I can continue doing the way that I'm doing it because this has been actually really good, versus, you know, I am going to take what I have now and put these resources back into the business if I need to go from five, six million dollars to twenty million dollars, because that's what's gonna take that.

Ashley Kent (11:48): on especially when they've been given the mandate, right? Of growth and, you know, and obviously leaning

Dr. Edisa Shirley (11:52): Yes. Correct.

Ashley Kent (11:54): into the resources that, you know, maybe the private equity group is able to provide to them. But I'm curious too from, you know, it's a good transition into a question I have of the gap between the money side and the realities of the clinician side within there. And I'm you y you being a clinician yourself, but also being on the private equity side of things.

Ashley Kent (12:18): You know, where do you see that investors maybe they don't really understand specifically within behavioral health? It's a unique nuance to the behavioral health space that, you know, is they should be more aware of that may be different than, you know, primary care MSO or something of the like that would be very unique to behavioral health that you could warn against or make sure that they're aware of.

Dr. Edisa Shirley (12:40): Yeah. You know, I I've lived that from probably just about every seat. So, you know, at at Refresh, which became a part of optimum behavioral care, you know, I was leading the post acquisition integration. And now through my advisory work, I sit on the other side of the table that, you know, I'm really I'm working on a pre-deal diligence for investors. So I really get to watch it exactly the same mistakes, repeat from both directions.

Dr. Edisa Shirley (13:07): This is kind of how I break it down. So before the transaction, understand what you're actually selling or buying, right? It is not just the revenue, it is not just the quality of your EBITDA, or it's not quality of the EBITDA, the payer mix, the clinician retention. Diligence will find everything that the founder seller has not fixed. So

Dr. Edisa Shirley (13:34): If I am on a seller side, right, my advice would be fix it before someone prices it against you, right? And also, you know, also good rule of thumb is when you're ready to when you feel like you're ready to sell your practice, add plus two years or at least 18 months to get ready if you want the best, you know, if you want to get the best value for your money.

Dr. Edisa Shirley (14:00): So that is like if you're a seller. If you're a buyer, that works in advantage, basically, because then

Ashley Kent (14:07): Always does.

Dr. Edisa Shirley (14:08): you, you know, it always does, right? Then during the transaction, the deal is a distraction machine, really. So you know, for the seller, you know, their team really disappears into data rooms for months, and somebody has to really keep up with the businesses,

Dr. Edisa Shirley (14:27): So the organizations that really come through the best are the ones that deliberately protect their operators from the deal process. And what I've seen many, many times is during that process, business it decreases in revenue because you have, let's say, five partners, right? And each one of them is a clinician. And now they're working on this deal, you know how much revenue you're losing.

Dr. Edisa Shirley (14:54): while they're digging through the diligence list. and then after I would say this is the part of people underestimate the most is the first hundred days set really the tone for everything. the clinicians at the practice, the truth is they don't really care about a cap table. they care about three things, right? Did my workflow change or did my work change? Did my pay change and did my autonomy change?

Dr. Edisa Shirley (15:20): And if the answer to those is nothing changed except now you have better support, integration goes well. If they feel like investors, which sometimes they do that, they come in and the corporate, they call it corporate lands on them on day one, and this is where you start bleeding that talent. And in behavioral health space, specifically, clinicians equal to

Dr. Edisa Shirley (15:49): Revenue lost the closest than in any other specialty because patients leave with their providers. They do. I mean, if you think about it, if you're if you have a therapist, you don't want to tell somebody else your full life story. I mean, basics, right? So

Dr. Edisa Shirley (16:06): That's something that it's very unique to behavioral health space and that integration has to be planned very well to ensure that those specialty providers, of course, staff as well, are feeling comfortable, that those questions get answered, and that, you know, that they understand what their life is going to look like after, you know, corporate takes over.

Ashley Kent (16:30): And obviously I you know, there's things you can put in the deal terms for, you know, maintaining those providers there, but an unhappy provider in a you know bad situation is, you know, equals, you know, not a great outcome also at the end of the day.

Dr. Edisa Shirley (16:44): Mm-hmm.

Ashley Kent (16:44): and I think that's incredibly interesting, and particularly on, you know, the private equity side, if you know, you in a good call out, if they don't have experience on the behavioral health side, you know, for them to it's kind of the the soft and tangibles of, you know, within the deal itself, like you said, within those first hundred

Ashley Kent (17:00): days, how are they making sure that the provider is feeling incredibly supported and you know they're living up to the promises that they said in the you know deal process. and you know it's kind of the warm and fuzzies a little bit to you know keep them keep them there because I mean those truly are going to be your revenue drivers within there. So I think it's an incredibly helpful perspective within that.

Dr. Edisa Shirley (17:21): Absolutely.

Ashley Kent (17:23): I'm curious from that kind of leans a little bit into the culture of that. And you know, you yeah, everyone has the private equity sort of, you know, scary. You know, it comes in, like you said, is it gonna be someone that's like really working with the practices, or is it gonna come in and just saying, hey, this is exactly how we do it, and you know, that corporate is coming in and stripping away the the culture of that. How have you seen different organizations be really successful at, you know, maintaining the culture and what made those practices really special and successful in the first place?

Ashley Kent (17:51): while you know making sure that on the back end they have the resources and the standardization that they need to run effectively as a practice and grow ultimately and finding that balance within there. What have you seen has worked well?

Dr. Edisa Shirley (18:05): You know, I think this is the question that I've probably spent the most years of my career answering. Because, you know, with even like a refresh and optimum, I I was involved with over a hundred of integrations across, you know, 300 plus centers in 30, I think, seven states. And the framework I landed on is simple to say and really hard to do. Standardize the back office, protect the front of the house.

Dr. Edisa Shirley (18:34): Right. So credentialing, billing, compliance, reporting, payroll, centralized those ruthlessly. I think there's a lot of value in it. No one's clinical identity lives in their billing workflow. no therapist has ever said, I love this practice because we how we submit claims, how we scrub the denials. You know, that that's where I think standardization is a pure when.

Dr. Edisa Shirley (19:01): But the clinical philosophy, community relationships, the local brand, this is where this is the way a practice shows up in its market. And that's the asset you really paid for. Touch it very, very slowly, or don't touch it at all. Where platforms get it wrong is sequencing. So they lead with a corporate playbook on day one.

Dr. Edisa Shirley (19:29): New name on the door, boom. You are not Susie's behavioral health. You are this is your new policy, new everything. And the acquired team immediately goes defensive, right? Because you know, now they feel like, okay, we've been doing it wrong. This has all been wrong. Where I've seen it work is when you flip the order. Your first moves.

Dr. Edisa Shirley (19:53): take work off of their plate, right? You clear their credentialing backlog, you fix their denial, you make their life easier, measurably easier, before you ask them to change a single thing about patient facing. Because really the thing is standardization isn't really a systems challenge. It's a trust challenge. And once an acquired team believes that the platforms make them better, they'll do anything for you.

Dr. Edisa Shirley (20:22): You you can adapt anything. You can you can really do whatever. If they don't believe that, even the best change that you're trying to implement later, it's not gonna work because they will push you back. That whole piece, that's a relationship piece. And I many, many groups have, you know, and I think we're getting better at it. And a lot of like investors and private equity groups are getting better at this, but investing in that.

Dr. Edisa Shirley (20:50): Integrations, culture, relationship, role. It it's it's the key. It's you know, it not everything's a playbook, not everything should be a check, you know, checklist where you go through it because if you shake that up, you're just not gonna recover. And then it's gonna come back to me. I'm gonna deal with the distress business. So, and I've seen it that as well. I've seen it where it's gone wrong and then they come back and

Dr. Edisa Shirley (21:16): They're like, well, we acquired this amazing successful business and everything was going great, revenue is going up and now it's declining. What's going on? It's usually that. It's usually people leaving, right?

Ashley Kent (21:29): Well, and you know, the people within the organization, not just the clinicians, but you know, front desk, office, anyone, I mean, they're the megaphone of what's happening.

Dr. Edisa Shirley (21:36): Mm-hmm.

Ashley Kent (21:37): I was working with a practice and we were actually just talking about this this past week, where, you know, they exact they have that exact strategy where, you know, after they acquire it's actually incredibly quiet. where it's very subtle shifts. They're going right into back office first and get getting the whole team bought in to this that like life is actually better with this. And what actually ends up happening is then they start talking about

Ashley Kent (21:59): We're now working with, you know, XYZ and you know, it's been awesome.

Dr. Edisa Shirley (22:01): Mm-hmm. Yep.

Ashley Kent (22:03): And they're able to, you know, be that advocate for you that then turns into patient-facing communications. And then you find that balance of all right, now at what point do we start to introduce that on the patient side? and it all depends too, you know, are you are you becoming a, you know, are you gonna be slapping on eventually like a consolidated branded house or you're gonna have a house of brands and they maintain that at some point, and that changes at what point you introduce the brands. but that's what

Ashley Kent (22:28): You've got the front desk already talking about it. and then

Dr. Edisa Shirley (22:31): Mm-hmm. Yeah.

Ashley Kent (22:32): what are those things you can start to introduce on the patient side that also makes their life a lot better? I'm working with a pediatric group right now, and you know, within the first 30 days, they just started offering text messaging, the ability to text your provider.

Dr. Edisa Shirley (22:44): Yeah.

Ashley Kent (22:44): which, you know, we know healthcare, wow, how wild they were introducing

Dr. Edisa Shirley (22:48): Mm-hmm.

Ashley Kent (22:49): something as simple as this. But I mean, as a parent that can quickly now text the provider when their kid has an ear infection, you know, it's just

Dr. Edisa Shirley (22:54): Yeah, yes.

Ashley Kent (22:57): amazing.

Ashley Kent (22:58): Immediately improvement. And so then they're starting to build that equity already by the experience versus just like, wow, we don't have a beautiful branded waiting room. No, it's what are those things that are actually making someone's life better? and how are you being really thoughtful in that? And I love how you said, yes, in the back office, get their biome. And then on the patient and you know, other side of it as well, what are those little micro moments that you can start to slowly introduce this without it being like a train has hit them and we're taking over.

Dr. Edisa Shirley (23:23): Yeah. No, a hundred percent. Yeah, no,

Dr. Edisa Shirley (23:25): a hundred percent. And there's already bad, you know, bad taste in a mouth for a lot of behavioral health. And I'll speak specifically for behavioral health, you know, of the bigger companies acquiring, right? So it already does not sit well. Like, ooh, it's a big corporate, even if you're the most amazing organization, it doesn't sit well, right? So you have to be cautious. Very personal, yeah.

Ashley Kent (23:48): is personal, right? Like

Dr. Edisa Shirley (23:51): It's inter you know, it's a relational business and you know, I think there's ways of doing it, but you know, just understanding how some of may perceive some of this change, it goes a long way.

Ashley Kent (24:04): pivot a little bit into you've been doing a lot of work within integrating behavioral health care into other you know specialties and what that has looked like. I'm curious where you've been seeing some of the most just interesting convergence within behavioral health and where you've seen this be the most successful and maybe unsuccessful as well on that side too.

Dr. Edisa Shirley (24:24): Yeah,

Dr. Edisa Shirley (24:24): this this is honestly a topic that I'm really the most passionate about. you know, behavioral health is escaping that standalone clinic where we used to be. And like, and when we talk about behavioral health, like even just 10 years ago, we were nowhere where we are today. So this is a very new it's a new field. It's a new specialty, especially within the like an investment world. so really the convergence.

Dr. Edisa Shirley (24:50): I'm seeing is happening in few unique directions. One that people really wouldn't expect, muscoskeletal and chiropractic care. you know, like at Clinic Mine, for example, we serve both chiropractic and behavioral health practices, and we've actually presented a continuing education on integrating behavioral health and mental health into chiropractic setting. So think about it. So you have chronic pain and depression, anxiety.

Dr. Edisa Shirley (25:19): and physical function, it's it's deeply intertwined, right? Patients don't experience their health in silos, but you know, but we build a delivery system that pretends that they do. So it it's it's interesting to see that how many patients that you know let's say get chiropractic care and then get also behavioral health care at the same time, how their outcomes

Dr. Edisa Shirley (25:47): actually on Cairo's side improved. So this is a really unique one and it's probably a newer you know a newer kind of integrated care shifts. second one is long-term care, skilled nursing, assisted living. The psychiatric need in those settings you can imagine is enormous and dramatically underserved.

Dr. Edisa Shirley (26:11): I think the latest statistics were that only 16 or 17% of individuals in post-acute care receive any kind of behavioral health services. And, you know, and I really think this is one of the biggest growth frontiers in behavioral health over the next several years. And then, you know, the third one, I think it's more that one's more talked about, it's primary care, right? Which is, you know, most established convergence.

Dr. Edisa Shirley (26:37): But still has a long way to go, especially on the execution part. And I think what's driving all of this is both clinical and economics. So clinically, comorbidity is the norm. It's not an exception. Economically, as value-based arrangements mature, whole person outcomes are really what's starting to get more rewarded. And you cannot deliver that.

Dr. Edisa Shirley (27:06): whole person outcomes like for example like in a chiropractic care they they do believe that a whole person approach which your emotional well being is you know is a part of it so you can't deliver those outcomes with behavioral health sitting in a separate building or in a separate system you know separate insurance you know all of that if it's if it's all you know delivered within even the same company

Dr. Edisa Shirley (27:36): it it's becomes more it provides better access to care and not just better access but better you know care overall and removes that barrier you know to integrated care for our patients.

Ashley Kent (27:50): What are the models that you've seen work best so that people can continue to do what they do really well? Is it you know partnering with someone who is able to build out that service line

Ashley Kent (28:00): Is it building it in-house? What have you seen has been the most successful to actually build out these lines that are successful and you know, but also feel integrated to the full service offering?

Dr. Edisa Shirley (28:11): I mean, I think the easiest step, which is you you know, would be phase one, if you're not able to let's say bring it in-house, is to partner, right? Partnership is probably the easiest, least risky approach if you're just trying to provide your patients a better, you know, better care. Where it's the most successful, if it's

Dr. Edisa Shirley (28:33): under the same roof, right? Doesn't need to be necessarily on the same roof, but if it's the same company where you are basically building out a separate service line under your, you know, MSO, for example. If you have an MSO building that service line, because that provides easier way of you know care coordination if you're using the same EHR, right? It's easier, right? So now the provider on each service line can actually connect.

Dr. Edisa Shirley (29:03): And collaborate better, like because they have visibility to the same you know, let's say documentation or treatment plans. but if you're not able to for any reason, because sometimes it does require capital if you're opening a whole new service line, you know, even just partnering with someone in in a community where you're like, for example, if you're a chiropractor and they provide behavioral health services, it it might be as simple as.

Dr. Edisa Shirley (29:30): you know, some kind of agreement where, you know, for referrals, right? Hey, we'll send you all these referrals and let's, you know, let's collaborate on them. you know, it can be simple as that, but it's not as effective unless you have a full control over you know, just even referral process and ensuring that referrals that are sent to another service line actually get followed up on.

Dr. Edisa Shirley (29:57): And that that you know, that they're acting on it and collaborating with that position.

Ashley Kent (30:01): because I think so much of what you've talked about has just been incredibly practical and super applicable to, you know, on both sides, on the on the money side, but then also on the operator side, as someone's considering, you know.

Ashley Kent (30:12): potentially partnering with someone and what it what should they be looking for. And so I'm curious, you know, from the perspective of you know the amount of deals you've been a part of, if you had a behavioral health platform today and you know you were told you needed to double it over the next three years, what would be the first two or three things you'd want to understand before building that plan?

Dr. Edisa Shirley (30:35): So as I've mentioned even like earlier, Hanakal, I think I would want to understand, you know, I would want to see credentialing. I would wanna see RCM pr practices or billing practices and understand people structure of people. And when I if I once I understand those three pieces, then building out a growth plan based on where we are.

Dr. Edisa Shirley (31:01): what resources we have available to us, what resources we need in order to deliver to that growth plan. But really would need to understand those three levers first before really digging into anything else. You know, some some things could be an easy fix, right? So let's say if I have a platform and it's struggling, it's leaking money, or you know, it's hemorrhaging money on a billing side. I I need to understand why before I can make

Dr. Edisa Shirley (31:30): Any kind of plan for the future? Are we are we even credential? Are we billing correct code? Are we compliant? Right? Like we haven't even touched on compliance. I know we haven't touched on AI, but we haven't touched on compliance because that will shut you down. And if you

Ashley Kent (31:43): Mm-hmm.

Dr. Edisa Shirley (31:43): are not compliantly billing, or let's say you're overcoding, right? That's a big, you know, that's a big issue. I mean, I think across healthcare, then are you growing in a in a wrong direction? Are you you know are are you

Dr. Edisa Shirley (31:59): heading the wrong way because as you get bigger, the issues that are small become big issues. So I think I would make sure touch those three credentialing, billing, and people. Who do I have? Who my leaders are, who my providers are, am I set for that? You know, and then also do I need to hire? And are the right people in the right places for, you know, for us to be set for this growth. So I would go there.

Ashley Kent (32:27): Well super practical both for, you know, anyone that's in under diligence and what they should be looking at, as they're looking at that, but then also a founder looking to sell eventually, like you said, getting ready in that one to two years. super, super practical there. So I wanna

Ashley Kent (32:40): Finish us off with you know something I'm gonna be asking everyone on Growth DX. and so it's it's the magic wand question, which I think is such a loaded question when it comes to healthcare. because there's so much that we would love to fix.

Dr. Edisa Shirley (32:53): Yes.

Ashley Kent (32:54): and you know, but if you got one had just one magic wand and you could fix one thing in healthcare, you had no budget constraints, no regulatory constraints, no politics, what are you fixing?

Dr. Edisa Shirley (33:09): access to care. And I know this sounds very a lot of people use the word, you know, words access to care, but truly don't understand what it means. Access to care means that every individual that needs care, if that is preventative or, you know, regular psychiatric or regular, you know, any kind of health care care that can that can get it. And within

Dr. Edisa Shirley (33:36): you know, appropriate time within appropriate time frame, and not having to go through multiple hoops, insurance hoops to get there because that hurts a lot. So if that could do one thing, it would be that if you need psychiatric care, if you need a therapist, you have access to them and you don't have to worry about if your insurance covers nine eight three seven, blah, blah, blah.

Dr. Edisa Shirley (34:03): That would be it.

Ashley Kent (34:04): I love that. Great answer. You know, that's that's the dream, right? And you know, there's lots of awesome

Dr. Edisa Shirley (34:09): Yeah.

Ashley Kent (34:09): partners that are out there making things more accessible. and you know, it's a it's a slog every day,

Dr. Edisa Shirley (34:15): Yes.

Ashley Kent (34:15): but I think that is incredible. So well, thank you so much for joining us today. You truly have such a wealth of knowledge that is, like I said, just incredibly practical and applicable for people to be able to take away from this. So thank you for being our inaugural guest.

Ashley Kent (34:32): Here on Growth

Dr. Edisa Shirley (34:32): Thank you.

Ashley Kent (34:33): DX, and maybe we'll find some time for a follow-up discussion for a part two, because there was a lot we didn't get to. So

Dr. Edisa Shirley (34:40): Yes, thank you, Ashley.

Dr. Edisa Shirley (34:42): Thank you. It was such an honor. Thank you for having me. And absolutely part two coming up.

Ashley Kent (34:46): Dr.