“In the beginning, you may overshoot and you may undershoot, but the more time and focus you can spend on it, you can then help drive the plan,” he says.
Despite his best predictions, Krubert reached a point where he was underpredicting, and in that six-month to a year time period, his job simply wasn’t fun like it had been.
“I was personally pulled too far,” he says. “Luckily, I go back to my training as an ER doctor, and many times in the ER, you’re pushed to the edge, and you can’t quit because someone will die or not die. That helped me in saying, ‘OK, focus on what you need to do here. Let’s simplify what’s going on and let’s have a plan,’ and then there was a light at the end of the tunnel.”
He became quite disciplined in his daily approach to the job — coming in each day, first making sure that clients were tended to, then ensuring his team was taken care of, and then spending the rest of his time doing the work that would help him out in a year.
“A lot of times managers will focus on what I have to get done today, and they don’t give themselves the two or three hours a day to spend on, ‘What am I going to do a year from now?’” he says. “It catches up if you don’t do it, and that’s where the discipline and proactive planning comes into place.”
This approach helped him stay ahead of the company’s revenue growth — which went from $90.2 million in 2006 to $261.6 million in 2009. After that kind of growth, the company is now able to better predict future growth.
“Now, luckily, we have four or five years of growth, and we know that if we’re calling X amount of clients, here’s usually what our close rate is, so we can get better at predicting,” he says.
Some of the keys that have helped Krubert successfully grow ApolloMD without falling on his face have been to promote the right people, build rapport with his clients and to put processes in place to ensure the organization’s service didn’t lag.
“If you don’t continue to service, the growth will stop,” he says. “It’s trying to keep the growth engine in line with the operational support, and that’s taken a lot of interviewing and meeting good people and hiring the right people and training them up and putting in processes and using IT support to support the growth that we’ve had.”
Promote the right people
It’s such a critical mistake, and Krubert admits he’s done it himself — hiring or promoting someone whom you really like but doesn’t have the skills to do the job.
“I’ve done it, and often, you’re very disappointed and so is the person that’s doing the job, and sometimes the likability goes away,” he says. “It’s less about who we like and more about who can do it.”
But you have to really know what you’re looking for in a position.
“It’s a disciplined approach to define the key characteristics of what you need in a person to do that specific job and completely severing the, ‘I like, I don’t like,’ and then tapping into other people’s sort of ratings on the same scale,” he says. “It’s pretty clear, hard work or not hard work. That’s almost a quantifiable type. There are ways you can define that and then ask other people who are in a similar role.”
Krubert uses a few key characteristics in determining if someone is suited for a position, and that includes the person’s work ethic, how he or she handles stress, his or her ability to provide good service and the ability to create relationships. To evaluate these characteristics, it’s not just a couple of interviews. Instead, new employees go through a two-year leadership academy in which they’re exposed to some of the best hospitals that ApolloMD operates, mentoring and apprenticeship programs, the Apollo way of doing things, and formal educational materials.
“In the end, those people have been exposed to almost all the problems,” he says. … “They’ve lived the experiences without having to worry about the mistakes.”
At the end of that training, when a new opportunity arises, Krubert is able to look at his top candidates based on the characteristics that he’s seen in their training to decide who gets a shot at running the show when the company signs on a new place.
“You get the good exposure,” he says. “You see them in multiple venues. You see them in a professional setting, and you see them in the clinical setting. One thing about working in the ER, you see them at their worst and best.”
He’s able to see employees when they’re tired, stressed and facing technical challenges. He also gets to see their personal side and how they work with patients and how they treat them and how responsive they are.
“It’s almost a little microcosm of a platform to say there’s a lot of transferable characteristics that would apply from working in an ER or a clinical setting that we could then say, ‘This person could probably apply those same skills to the management side,’” Krubert says.
Build client relationships
One of the biggest keys to ApolloMD’s growth is excellent service, and that relies on building relationships with clients.
“That doesn’t mean wasting their time with lunches every month,” Krubert says. “It might just mean when you’re there, using the valuable time to ask the right questions. Don’t spend all your time selling, because most of the time, they have you there because they already bought you.”
He says you should strive to understand their organization and help them to see how you’re able to bring value to them.
“First, what’s their vision for either their company or service line?” he says. “How will what we do specifically apply to that?”
For example, if the client’s goal is to grow its revenue base by 20 percent, how does the ER fit into those plans? What are the exact expectations that the client is building into its budget?
“You can’t ask those questions unless you have a personal relationship and there’s trust and credibility,” he says. “You have to know their language. … Then it’s understanding, ‘OK, ER, you budgeted in 20 percent growth in the ER. Here’s our plan to get you there, and does that seem in line with what they’re specifically trying to do?”
The key is to make sure you’re asking good questions so you can have the most and best knowledge.
“Ask probing, delicate questions to make sure that their vision is consistent with what our plan is and then update it periodically,” Krubert says.
It’s also important to make sure you understand the individual you’re talking to and get to know them as a person as well.
“There’s many times they may have their own personal challenges,” he says. “Their job may be on the line if they don’t hit certain metrics. If you can understand what their personal goals are, whether it’s job preservation or maybe specifically growing it so they can get their bonus.”
Krubert takes it a step further and aligns his people’s goals with those of his clients so that everyone has the exact same metrics.
“Now, when they all win, they’re all happy, and if they don’t win, they’re all going to cry together,” he says.
It eliminates politics or hidden agendas from one party or the other when everyone is striving for the same thing, and they’ve seen a true performance bump by taking this route.
Then the last element of building strong client relationships has been to be open and honest about expectations.
“It’s very easy to sell one thing and not deliver,” Krubert says. “Reputation is what drives us and growth, so make sure what you sell and what you promise can be done. Before you promise something, you may want to do your research if it’s a technical or very specific number. It’s important to ensure what you promise you can actually deliver on.”
It’s important to also discuss the risks with your clients so they’re clear about not only what could go well but also the chances that something could not happen as planned.
“Giving them specific data and having them trust that you say you’re going to do it, you deliver, that builds trust because the next time you come in and ask for it or they ask for something, there’s that trust element,” he says. “In our business, personal relationships are huge and your reputation is important.”
Put processes in place
When you’re seeing 2.5 million patients a year like ApolloMD’s staff does, 2 to 5 percent inefficiency can create a lot of problems, so Krubert has had to put processes in place to keep up with the growth and eliminate inefficiencies that could affect their service.
One of the biggest processes he’s implemented is with the physician credentialing procedure. When a physician works at a hospital, he or she has to go through the appropriate paperwork to get an ID number from Medicare in order to get paid for the work. If that doctor works at multiple hospitals, he or she has to have a number for each location. If the company picks up a new hospital, it then has to credential all of those physicians. The paperwork is long, tedious, has a lot of room for error, and once submitted, it could take months to get the approval. There are a lot of moving parts with it, and many companies have gone under because of not keeping up with it and being able to collect the money that’s owed them.
At one point, only 80 percent of ApolloMD’s credentialing was up to date, so 20 percent of the time, it was lagging, which had a huge financial impact. Krubert identified this one process as the most critical to the company’s overall success.
“Invest in data and metrics, not just metrics that your clients use but metrics internally, trying to make them simple but sort of poignant,” he says. “You have got to understand what is the key component that determines success.”
He says that this should be something that you measure or have a way to measure.
“You have to come up with ways to measure it, whether it’s technology or simplifying your process, but then monitoring it and benchmarking it and having historical data, so you can do a trend analysis and, when you’re pointing toward the worst direction, you can act,” he says.
“What I’ve seen is that companies, as they get bigger, it gets so complicated you don’t even know where to start in the day, so if you can simplify your business with a handful of measurable metrics, and then, more importantly, communicate that to your team and then align the incentives of your team with those metrics, those are the key elements that define success in whatever department.”
Krubert spent a lot of time studying lean and Six Sigma methodologies to implement processes to speed up this procedure.
“It takes senior management to really understand and know your business, to know all key elements of the processes that go in,” Krubert says. “If you don’t know it, either learn it or tap in to the expert person in your department and have them work closely with making it. Oftentimes, people who aren’t experts at all will come up with way too many things to measure in terms of key success or make it way too complicated rather than this is the one sort of statistically objective measure that will be directly aligned with the overall success of the organization. … It all has to be connected to the goal of the company.”
After putting processes in place to improve this one procedure, the company is up to between 98 and 99 percent successful credentialing, which means when a doctor sees a patient, the bill goes out that day instead of in three or six months.
“When we’re efficient and we’re low-cost internally, our administrative overhead expense is low, and we can pass that through to our client, which is a big deal in health care today,” Krubert says. “You can’t just be good and nice; you have to be low cost.”
How to reach: ApolloMD, (770) 874-5400 or www.apollomd.com