There are a lot more independent physicians who are looking at the world and thinking they didn't go to school for in some cases, 20 years to run payroll you

Austin, welcome to off the chart, a business and medicine podcast featuring lively and informative conversations with health care experts, opinion leaders and practicing physicians about the challenges facing doctors and medical practices. My name is salsa Luttrell. I'm the Assistant Editor of medical economics, and I'd like to thank you for joining us today. In today's episode medical economics, senior editor Richard Pearson spoke with David Ford with David Ford, CEO of Medway, a new business support program launched by the California Medical Association to help independent physicians focus on practicing medicine instead of managing paperwork. Medway offers subscription based services that handle HR, payroll, benefits, insurance and other back office operations for smaller physician owned practices. Ford explains how the program was created, what services it provides, and how it aims to strengthen independent medicine by giving doctors more time to focus on patient care. David, thank you for joining us, and now let's get into the episode.

Thank you for joining us today.

Thank you for having me. Richard, it's a pleasure to be here. Can you

introduce yourself and describe a little bit about your background? Your background and

experience? Sure. So as you said, my name is David Ford, Chief Executive Officer of CMA physician services. We are the practice support and practice transformation arm of the California Medical Association. In my background, I've actually spent a pretty fair chunk of my career working in this particular field of practice transformation and practice support. I came to this job from running one of the federally designated Regional Extension Centers, which were, as you probably know, were funded by the Stimulus Act back in the days of the EHR Incentive Program and meaningful use, I founded and then ran an organization called CalHFA, which was the largest regional extension center in the country. And then came back to CMA in March of 2020, and now, as I run CMA physician services, there's

another segment involved with this. Today. We're going to talk about Medway. Can you introduce Medway and explain how that started? What was the reason for it?

Yeah, it's actually, you know, it's a new offering from CMA physician services, kind of a different one, to be honest, and something we're very, very excited about. The easiest way to describe it is actually to talk about how we got to this point. About three years ago. The CMA physician services team did a very, very deep dive on independent medical practices. We did one on one meetings, surveys, focus groups, kind of a little bit of the you name it to really try to understand what the challenges were. We've all seen the numbers right. Independent practice has been declining, especially in California, where we're a highly integrated medical marketplace, and we really wanted to understand what were the things that were, what were the challenges that were facing the independent practices, we tried to go in with just no preconceived notions, just asking physicians, what keeps you up at night? What are you facing? And while there were a lot of things, you know, a lot of topics that came up, one thing that came up over and over and over again were what I call the quintessential Small Business hassles of running a medical practice. A lot of physicians started talking to us about HR problems, staffing, payroll, benefits, insurance, right? These sort of back office small business challenges of running a medical practice, almost 100% of the physician we talked to said that was a problem, and my team took a step back, and we thought this really feels like something we might be able to help with. So over the last three years, we developed a really comprehensive offering that we now call Medway, where physicians, on a subscription basis, can outsource all a lot of those functions into out to Medway. We have an online platform where they can manage all of their HR from time, keeping payroll compliance, yes, even in very complicated California, their employee benefits all in one place, one login. We also have a support layer where we have HR specialists on our team so physicians don't have to call one 800 Number or deal with an AI chat bot. They have a human being who understands them, works with them, knows their practice, that they can call anytime to get the support they need. So it's, I say, it's a little different from things we I've done before, but we are very excited about it. We feel like it's fitting a really important need in the physician marketplace. I

understand that Medway really kicked off just earlier this year. Is that correct?

Yeah, end of April of this year. So we the response has been really amazing. We we hit all of our first quarter numbers. So that's obviously, when you launch a new thing, that's that's the best part, and we have a really strong pipeline that's growing of physicians who are interested. What's also been interesting is, you know, even though we started in California, we've started to get interest from some areas back east, other medical societies, some, some of our other partners have approached us about, you know, can we turn on Medway in their state? So that's something that we're looking at. We're trying to figure out the model for that. But right now, all of our work is in California, but we expect that within the next year or so that will that will be expanding.

Definitely want to touch on that, hopefully in a few minutes here. But I was also curious to find out regarding the reaction and response, and maybe to go back to some of the when you mentioned about the deep dive and some of the demographics about the physicians, it seems as though there's a pool of physicians who really like being business operators. There are some who sort of, you know, figure out how to handle it, and then there are some who really just want to focus on medicine. And certainly that's a noble desire and occupation as well. I guess. Can you talk a little bit about that sort of dialectic that goes on about independent physicians, both serving patients as physicians as well as being small business operators, and some of those challenges again.

So I think what we found is there are a lot more independent physicians in that last bucket who you know are looking at the world and thinking they didn't go to school for, you know, in some cases, 20 years to run payroll, right? And we know that some of those hassles are why physician burnout is so is so epidemic right now. Because, you know, these, these physicians are trained to treat patients. And I think a society that's what we want, right? We want them in that exam room, treating their patients, doing what they are very, very highly trained to do. And I think the you know, that was the thinking behind Medway, the more of all that other stuff we can take off their plate, the better will restore some of that joy of being a physician. They can spend more time working with their patients to, you know, to heal disease, which is what they're trained to do.

Say, Keith, this all well and good, but what if someone is looking for more clinical information? Oh, then they want to check out our sister site, patient care online.com. The leading clinical resource for primary care physicians. Again, that's patient care online.com.

I'm really glad you touched on that point about workplace conditions that may contribute to burnout, because I joined medac in February 2022, and was made a long career as a community journalist. But I was very surprised to learn at the levels of burnout among physicians and other clinicians. And, you know, anything we can, sort of anybody can contribute to, kind of helping that, frankly, I feel, is certainly important in the sector.

Yeah, I mean, it's, it's especially coming out of the covid 19 pandemic, we know that physician burnout is incredibly high. It definitely appears to be acute among the independent practices, because they do have to play that dual role of running a business and being a physician. And to your point, yes, some of them really like that entrepreneurial small business person feel, but we others that we found a lot more who look at all that as an impediment to being a really great physician, having that really good connection with their patients, which is what they went to school wanting to do. We serve

a national audience. And one thing I was curious about, because sometimes I think we go about our jobs and, you know, we're kind of hyper focused on each of our different, everybody's different topics and focus areas for some of those physicians who are in other parts of the country, when you made that deep dive, were there any business? Conditions or regulatory conditions in California that are especially favorable for independent practice? It's

an interesting question, because I think it's no secret that for the very specific piece of this we're trying to do, human resources, California does tend to be very, very complicated. You know, there, there are some things that are helpful in California. You know, we have our, our long standing medical malpractice market is pretty good because of some work that CMA has done. We just on the ballot last year, passed a problem, what's called Proposition 35 that once we figure a few things out, should be increasing our Medicaid reimbursement rates in California, we think will be incredibly helpful to independent physicians, you know. But other than some of those few things, there's a lot of pressure on independent physicians. Obviously, it's harder and harder to compete in a marketplace against very large integrated medical groups.

And this was a point that I think you touched on talking about those physician members who have that desire to serve patients as best they can. Medway's website declares independent physicians as the backbone of our healthcare system. Can you explain why it's so important to have independent physicians as part of the healthcare environment, both medically and from a business standpoint,

yeah, I think that medically, you know, from sort of the healthcare perspective, you know, the The patient outcomes from independent physicians are incredibly good. We know that independent physicians are more likely to work in underserved areas to treat underserved populations. They are and they are incredibly good at building that really personal connection with their patients that is so important for so many people to have favorable health outcomes from a business perspective, one just from capacity perspective into you know we we have a shortage in this country. We need as many physicians and sort of all different practices as we can. But I think it is especially important to have those independent physicians, because they they they serve those populations that sometimes others don't want to touch. You know, I think especially in California, independent physicians tend to be very diverse. We have a pretty fair number of women independent physicians who, you know, who have that connection to these community, to these communities, and provide them really good care and really favorable outcomes.

And you know what? It's a great segue to something I wanted to ask about related to not only the physician population, but sort of the support staff population, because you mentioned, and rightly so, a shortage of physicians nationally. There's great strain on on support staff, nurses, medical assistants, practice administrators, human resource administrators, and yet, at times, some of those office functions might almost seem like an afterthought. You know, obviously the first, the first point, of course, is always to treat the patient in an era when healthcare is facing a shortage of workers. How does that business efficiency make a difference for physicians as they interact with their support staff.

What we hope is it frees up a lot of time. You know, as I say, I've talked to so many independent physicians who have stitched together their back office functions, some of whom stop every two weeks to fill out, you know, to process time cards and process payroll. It's not a good use of a physician's time, right? It's not a good use of staff time. It's something that can be automated. And what we hope is is a few things, one that, yes, that frees up more time for patient care, you take some stress off of everyone in the practice to outsource a lot of those functions, also hopefully feeling like they have a support team that can help them, because in any business you have HR headaches. And what we also hope is that it gives the physician and their. Support staff, the opportunity to go home to have dinner with their family, because they're not sitting in the office processing payroll. When that can all be done by our platform

to get into maybe some nuts and bolts here. Can you describe the logistics of Medway? You know when a physician or a group of doctors, a small group may be interested in using that service. Can you walk us through the signup process? How do they enroll?

Sure we have we have a pretty quick onboarding process. The main component is our HR is human resources, information system platform, it's online. I say one login. Everything is integrated with one exception under federal rules, you're actually not allowed to integrate retirement plan onto these HR platforms. But everything else, the benefits, payroll, compliance, all of that works through one login. So we just get an employee census. We onboard them all into the platform. We give this the physician and their staff training on how to use the platform. And then from there, let's say we we can support them as much or as little as they need, and some of our practices just take that platform and go and some of those platform of our offices need a little bit more hand holding through the process. And we're we can do it either way. The other thing is, if there are those trainings that we have to do. So in California, there's trainings on, you know, like sexual harassment prevention, workplace safety, all of those are actually built into the platform. So that's another just box we can check for you, because you do have to do all that as an employer. So we tried to make this very, very what's the word? Very comprehensive, I guess is the best word I'm I can use. You know, one of the things we heard from a lot of our practices is one of the things they find overwhelming is having a million logins, a million passwords to remember. So we as tried as much as possible to put everything in one place, one login, to make it very simple and straightforward.

This was something that that comes up time and again in healthcare and maybe sort of a two part question, because the element of cybersecurity is something that we cover extensively as well. Does Medway end up touching a lot of patient records? And if so, are there cybersecurity measures that will protect that confidentiality?

So easy answer to that question, no, we do not touch the patient records. We don't touch the electronic medical record system. That is by design. So we have, you know, our platform has very good cyber security for, obviously, the employee records, which are important too, but for those concerns about HIPAA and then in California, what's called CMIA. No, we, we, we don't touch the patient records. We steer clear of all of that

in any small business enterprise, whether it be medical or any other sector, obviously, owners are always trying to manage their costs. Can you talk about the cost of Medway and how you remain competitive, especially for smaller businesses that may be running on a somewhat tight margin,

sure, and it was a really important focus as we built out Medway. Basics of the pricing, it's $89 per employee per month. There is a about a $2,000 setup fee that's just to get everyone up and running on the platform. It's one time we're and we, we built that pricing model to be much more affordable than most of our competitors. So there are, I won't name names, but there are the, what are called the PEOs out in the marketplace, we found that they start anywhere around about $150 per employee per month. And what's particularly challenging a lot about a lot of those PEOs for smaller practices, is that because they're very large and they have fixed costs. Their per employee per month costs are higher for smaller employers. So we have seen for some of those PEOs that their per employee per month costs, if you're a five employee shop, can be three to $400 per employee. Per month. So ours is flat fee. If you're five employees, if you're 50 employees, it's $89 per employee per month. The other thing that we think is important, and part of how we kept down our costs, is we don't do what's called co employment. So you may know that a lot of those, the those other organizations, they do what's called co employment, where they're actually the employer of record, and you are leased back to your what looks on paper like your employer. A couple of things. One, we found there's not really an advantage to doing that. And two, we thought it'd be a little strange to approach an independent practice and say, Hey, we want to help you remain independent by employing all of your staff. So we thought that was a that adds a lot of expense to no real benefit. You. It.

Hey there. Keith Reynolds here and welcome to the p2 management minute in just 60 seconds, we deliver proven, real world tactics you can plug into your practice today, whether that means speeding up check in, lifting staff morale or nudging patient satisfaction north, no theory, no fluff, just the kind of guidance that fits between appointments and moves the needle before lunch. But the best ideas don't all come from our newsroom. They come from you got a clever workflow. Hack an employee engagement win, or a lesson learned the hard way. I want to feature it. Shoot me an email at kreynolds, at mjh life sciences.com with your topic, quick outline or even a smartphone clip, we'll handle the rest and get your insights in front of your peers nationwide. Let's make every minute count together. Thanks for watching, and I'll see you in the next p2 management minute.

And to continue some discussion of some logistics, a moment ago, I had asked a little bit about patient records and confidentiality. That way, does Medway work with patient billing and reimbursement?

No, at least not at the moment. It's something that we may look at down the line. But, you know, I think as we built out our initial offering, we really wanted to meet the need that we heard the most. And the one that came up over and over and over again, which was this HR, these HR functions down the line, we may look at some other things that are possibly a little more physician specific. We do also have some partners who are in the billing collections, rev cycle space that we could refer physicians to if they really needed that. But for the moment, it's not part of the Medway offering.

Regarding how Medway operates under CMA physician services, I was going to say, Do do you publish a report to members, say, or a report generally that would include specific figures about the response so far,

if you're looking like you know, since we've been in the field for 15 weeks at this point, we haven't published any any reports yet, I will say, you know, as I say, we close out the first quarter, we had what we thought were kind of conservative, very modest goals for our growth. Partially that was wanting to be realistic about launching a new company. But partially that was too we're trying to be very thoughtful about how we grow, because we wouldn't want to bring on a whole bunch of practices right away and not be able to give them a level of service that we expect from ourselves, and we think that our physicians will expect from us. So we're we're being conservative, we're being thoughtful, but we have, I think it's about 60 employees under management right now. Very, very it's a different way of thinking. I think for those of us who work in medical associations, who are always thinking about how many physicians are in the practice, we have to think about how many employees are in the practice. It's the physician and all the staff. So, yeah, I think our first quarter goal was about 60 employees, and we hit that, and we have a pretty good pipeline. So, but no, we're not publishing anything yet because we're just getting our feet under us.

Absolutely it'll take time to develop and and hopefully thoughtful growth is better than it sometimes can be much, much better than too rapid a growth.

So yeah, we know. And we've seen some some other similar type offerings from other associations where they try to take on. Many practices right away. And you know the when a new practice comes to us, the physicians talk, right? They a lot of them know each other. They talk, and we knew going in, if we tried to grow too fast and we couldn't provide a good experience, especially for those essential first practices in the door that we would kneecap ourselves right out of the Kate and we would get a reputation of not being able to provide good service. So as I say, we're trying to be very measured, very thoughtful, make sure that we're staffed appropriately, so that the physicians, as they come to us, they have a good experience, and they feel like we really are the partners that we want to be

among the 50 states. Obviously, that's a lot to keep track of at the state level. Are you aware of any other state medical associations or societies that are offering this level of management service for independent physicians?

Not that we found, you know, I think we found other medical societies that offer pieces of what we're offering. So we've talked to a few of the medical societies back east and that offer, like some of them may have a retirement plan that they help with. Some of them have have like staffing services to help you source staffing. So we found some of those pieces, the HR Payroll pieces that we offer, we have not found that anywhere, and as I say, that's why we've actually had some conversations with some of our colleagues in some of the smaller states back east about how we could pair up the Medway platform with some of those pieces that they already have in place. But obviously, I'm not going to name names at the moment, but, but yeah, I think we're at some level of conversation with about four or five of our fellow medical societies back east,

not to get too deep in the weeds on that. But do you would you anticipate that Medway could serve as a as a business model for other societies to pick up on? Or would you provide management services across state lines, or both we

we certainly could. And you know, as we've talked to other other societies, the model may look different depending on which state we go into, how much, how much we're doing, versus how much they're doing. We've looked at a couple different options for that. What I've kind of said to a lot of my colleagues in other state, state medical societies is, you know, we spent three years building this thing. It's a lot of headaches, a lot of sleepless nights. I think I had more hair when we started this process. And what I'm hoping for these other medical societies and these, you know, these other organizations, is to save them a lot of that heading to say, look, this thing is already built. The platform, our integrated insurance broker, our retirement broker, our our staffing components, all of this stuff we can turn on in any of the 50 states pretty quickly. So what I would hope is to save a lot of those societies everything that I just put myself through and my colleagues put themselves through for the last three years and say, No, let's partner up on this. Let's not waste a lot of time rebuilding this over and over and over again when we can just bring it partner up, bring it to your state. The The other thing I will mention really quickly, because kind of unrelated thought, as we've as we've rolled out Medway, we've been approached, for example, buy a few dental practices. So, you know, HR Payroll looks pretty much the same in a small dental practice as it does in a small medical practice. So for at least this sort of, what we call Medway 1.0 this first set of offerings, we are in pretty deep conversation about signing up a few dental practices, so that's part of the conversation too, while we're talking about other states also, what are some maybe similar, what are maybe some similar healthcare providers out there that we might be able to provide assistance to as well?

You know, what a great segue to a question I probably should have asked. Is Medway built out to really serve a single medical specialty, say, or can you handle different specialties that remain independent?

Yeah, we, we can really serve any medical specialty, I think because we're not. Touching, sort of what I call the front the front office part of the practice, right? It's so really, the HR, the payroll, the benefits, the insurance looks, looks remarkably similar in everything from, you know, we've had conversations with pediatric practices up to neurology practices to ENT right? It's even some of the surgical specialties. This part of it looks essentially the same in any of those. So at least from the medical specialty, you know, it's not even something we think very much about. I was going

to say we've covered a heck of a lot of ground in a short amount of time, and it's been a great introduction to Medway. What did I not ask about that you would like our audience to know?

You know? So a couple things I will give the plug. We do have a Medway specific website, www dot Medway docs, docs.com quick, just funny story, you go to sign up a website, apparently, medway.com belongs to a shipping company that ships in the Mediterranean. So yeah, so we're Medway docs, docs.com, you can also find us on LinkedIn, Instagram, x.com, right? All the social media so we, you know, folks want to just take a look for themselves and see more information where we're not hard to find. And you know, I think, other than that, I would just say that, you know, we, while there are other, other, say, other competitors out there in the marketplace, we've, as we've talked about, we think we are the first one that was built by a medical association with the idea of supporting physician practices, those independent practices, and oh, you know, now that I mentioned this one more thing I'd mentioned, what's been really interesting as we've rolled out Medway, a few of the first practices in the door are actually brand New practices, folks who are staking out on their own, hanging that shingle, starting their own independent practice. Our customer number one is an ENT from the Central Valley, breaking off a very large medical group. She and two of our partners starting their own practice, and that's actually, I think, been very, very heartening to us, where we've had the opportunity to be on the ground floor doing everything from helping them write job descriptions to sketch out, well, what staff do you need? They asked us to ask one of my team to sit in some of the early interviews and give a perspective, so that, I think for us, from medical association perspective, is really, really exciting to be able to launch new practices, because, again, we do have that shortage, and looking at that, those opportunities to build more independent practices is really cool to us.

I'm Richard payer chin, reporting for medical economics. My guest today has been David Ford, CEO of CMA physician services, a subsidiary of California Medical Association. It's been a great conversation, and thank you so much for your time.

All right, thank you for having me, Richard. You Hi once again.

That was a conversation between medical economics senior editor Richard perishin and David Ford, CEO of Medway. My name is Lawson Luttrell, and on behalf of the whole medical economics and physicians practice teams, I'd like to thank you for listening to the show and ask that you please subscribe so you don't miss the next episode. Be sure to check back on Monday and Thursday mornings for the latest conversations with healthcare experts, sharing strategies, stories and solutions for your practice. You can find us by searching off the chart wherever you get your podcasts. Also, if you'd like the best stories that medical economics and physicians practice publish delivered straight to your email six days of the week, subscribe to our newsletters at medical economics.com and physicians practice.com off the chart, a business and medicine podcast is executive produced by Chris mazzolini and Keith Reynolds and produced by Austin Latrell. Medical economics, physicians practice and patient care online are all members of the mjh Life Sciences family. Thank you.