The Edge of Healthcare: The Journey of a Global Healthcare Leader

Martin Cody: Welcome to the Edge of Healthcare, where the pulse of innovation meets the heartbeat of leadership. I’m Martin Cody, your guide through riveting conversations with the trailblazers of healthcare. Tune in to gain exclusive access to strategies, experiences, and groundbreaking solutions from influential payer and health system leaders. This isn’t just a podcast, it’s your VIP ticket to the minds shaping the future of healthcare right now. Buckle up, subscribe, and get ready to ride to the Edge of Healthcare, where lessons from leaders are ready for you to use today.

Martin Cody: Outstanding! This is one of the episodes I’ve been waiting for. Ladies and gentlemen, welcome to the Edge of Healthcare: Lessons from Leaders to Use right Now. My name is Martin Cody, senior vice president of sales and marketing with Madaket Health. And today, we’re going to talk with someone who has terrific wisdom on both sides of the equation, from the consulting aspect in the world of great consultants to also the tactical operational components of a large healthcare company. Today, I welcome Sri Velamoor, the president Chief Operating Officer of NextGen Healthcare. Sri, welcome.

Srinivas Velamoor: Thank you, Martin. Great to be here.

Martin Cody: Thanks so much for jumping on. And I think it’s important to get someone with your experience right now as we enter the second half of 2024 as it relates to healthcare, because there’s a lot of interesting things happening in healthcare as we speak, and it’s moving at a light speed pace. But I’d like to slow that down a tad and kind of start with a little bit of your bio. Tell the folks how you got started in healthcare.

Srinivas Velamoor: Yeah, I fell in love with the idea of a healing and helping people at a pretty young age, Martin, and always had it in my head that I wanted to be a doctor. By the time I got to a later years and in college, I also fell in love with technology. And that’s essentially spawned where I ended up today, just this notion of being able to take technology to transform the whole practice of medicine and care delivery, and then use the combination of both of those to impact how people access care and live healthier and fuller lives. So that’s been a lifelong passion and something I’m really excited to pursue.

Martin Cody: Now, two things I want to pull on there. The first, in reverse order, you said you had a passion for looking at the total delivery of care and technology combined in that. That’s a fairly grandiose vision. That’s a, that’s starting with the mountain. Most people would go, Ah, I’d like to impact patient care in a rehab center. But you’re looking at the totality of it and the care delivery aspect of it. Where did that stem from?

Srinivas Velamoor: Well, I’ve grown up all over the world in different countries. And when you look at the relative inability to access care and health services at different parts of the world, particularly places like India and Africa where I grew up, you can’t help but wonder if there aren’t opportunities to scale and get better leverage and provide these capabilities and these services to a broader swath of the population. And that probably is what planted the seed in my head, that there’s got to be a better way to do this than having individual doctors come and knock on a thousand doors and 2000 doors. And the more I’ve been in the engineering and technology world in the last 3 or 4 decades and seen the advancements, that conviction has gotten stronger and stronger, that sure, you were not leveraging the best of everything available to us to open the doors to more folks.

Martin Cody: It seems to be a perpetual and inextinguishable flame of desire, which I think is great and needed in health care. You mentioned you grew up all over the world. I believe, I know you attended undergrad at Duke, and did you, give us a little bit of history on where did you grow up.

Srinivas Velamoor: At least ten different cities in India until I was 13. I lived in the Middle East and Bahrain for about four years. Had a chance to see Saudi Arabia and Bahrain and the United Arab Emirates in my teenage years. Immigrating to the US, senior year of high school. Got my undergraduate in North Carolina, as you noted, Martin, and then got the itch to travel again and then promptly left two years after graduation to go roam the world for another 4 or 5 years and work all over Asia and Australia and the United Kingdom, and eventually made my way back to L.A., where I’m married with kids now.

Martin Cody: And what took you business-wise? I know I saw an engineering degree or multiple engineering degrees in your background. It was at the engineering that had you going around the world or did, was it healthcare or both?

Srinivas Velamoor: This mash-up concept of technology and healthcare, that’s a theme and other aspects of my life as well. I combined different aspects of my education into a consulting career early on in my life. And at its core, it was really about creative problem-solving, using different disciplines. And that is a thematic took me to different organizations and different industries and sectors around the world, gave me the opportunity to see amazing places and work with great companies like Goldman Sachs and Morgan Stanley and Amex and others over the years.

Martin Cody: All right. Was that with McKinsey?

Srinivas Velamoor: It was with different companies. It was initially with a small firm called Diamond Management Consulting. Okay, it was less than 200 folks. We used to get seconded to global corporations to go become part of internal swap teams, if you will, to take on problems. I originally landed in Hong Kong to lead the Y2K command center, for those of us old enough to remember the fuss around that.

Martin Cody: We’ll put a definition for Y2K in the liner notes.

Srinivas Velamoor: But that was fun. And then that led to doing a startup with some friends in Philippines and Singapore in the financial services technology space. And then I kicked around, and then I actually ended up at McKinsey about 13 years ago after a stint at Diamond Management Consulting.

Martin Cody: And I’m curious, did you ever sit there as a young Sri, traveling the world, going, what on earth am I doing? Were you ever overwhelmed with the possibilities and opportunities in front of you? From a standpoint of I’m just a, where did you get the confidence, I guess is what I’m asking? Or did you ever think I’m just a kid from India that’s grown up in X different cities in 13, by the age of 13, how am I getting this opportunity? Was there a mentor involved? I’m fascinated by this.

Srinivas Velamoor: Too many mentors and too many people have thanked, Martin, to be quite honest. I have to be honest. Even today I sit and pinch myself wondering how the heck I ended up where I did having grown up where I did. It’s been a good fortune of just following my nose and being surrounded by incredibly ambitious and smart people listening to them, in many cases copying them, and lots of folks along the way who saw a guy who had some passion, some interests and decided to nurture it at the appropriate time. Too many people to think. But it’s been a path less traveled, a fortunate kind of stringing together a lot of different opportunities along.

Martin Cody: That’s fascinating. And I think there’s some shareable wisdom there with regards to too many people to thank, which is a very compassionate and gracious comment because I believe that would be great ideas or wisdom to share with people that are now entering the healthcare market, or maybe have been in the healthcare market two or 3 or 4 years and are trying to find their way, is find someone, as you mentioned, who’s been there before, done it before, and learn from them. And don’t be afraid to ask them for some guidance, some knowledge, some wisdom. Is there anything I should be doing differently type of stuff? Is that kind of what you did?

Srinivas Velamoor: Indeed. So I certainly went around asking for a lot of advice from folks that I worked with over the years. But for folks in healthcare, I will say this. You said at the start of our discussion here, it is an incredibly complex space. You could study every individual sector in our industry and spend your entire life studying it. What’s fascinating is, as a young person, if I was starting all over, I would try and find folks that understood the pharma world, the payer world, the provider world, the technology world, the investing world, the banking world. These aren’t discrete silos. They all come together in very interesting and unique ways and not mention government advocacy and the policy world well. If you get the opportunity as a young person, find someone knowledgeable in each of these 6 or 7 areas and then they’re here for 20, 30 minutes, I think this view from the mountaintop of how all these pieces come together is incredibly valuable to solve any tactical problem in any particular corner or sector.

Martin Cody: Completely agree. And I’m wondering, it just made me think of in today’s virtual world how that might be more complex or challenging, because you can’t have the coffee powwow with the CEO in the office once a quarter type of thing. Do you have any ideas on how a new person or new-ish person in the industry can make themselves available to that type of leadership mentality, and that brain trust? Air quotes, if you will. How do I get access to him or her?

Srinivas Velamoor: That’s a great question. There is no question that it’s harder to put yourself physically in these places. I’d say on the flip side of it, there are more resources available to the average person to just go find on the internet or hear podcasts like the one you’re hosting right now. Martin, and avail themselves of at least a starting baseline of what all these are from the get-go. I found community sites like LinkedIn and others to continue to be useful. Of course, they have their limitations, but you can form forums and groups in these online communities. And one of the interesting things that I’m seeing, some of the younger folks do at places like McKinsey and others is: take their personal motivation and drive and convene forums. There are business schools, universities that host industry events and conferences where they invite folks to come meet students and have coffee chats and talk about issues. Many corporations have budgets that allow their employees to go in and do the same. So there’s a little bit of a how hungry are you to learn? And are you willing to go find the resources locally available to you to try and create these forms where they don’t exist, to meet with people and connect physically?

Martin Cody: That’s a great point. I think everything comes down to effort and work, if you will. And that’s certainly part and parcel to making yourself, getting exposure to these individuals, finding things in the community, finding things online that you can participate in. Brilliant point. And you mentioned McKinsey, and they’re in arguably a class by themselves or very elite class. And one of their excellent modalities, if you will, is their Leap methodology. And you talked about some of the aspects of these seven disciplines. Is that philosophy that you have today about those seven disciplines, is that from Leap per se, or is it a little bit of a wonderful blend of things Sri has learned over the years that these are the areas of focus?

Srinivas Velamoor: It’s more the latter, Martin. I think the, one of the special things about McKinsey is its access to industry leaders of various disciplines and its ability to convene these thinkers and leaders. So I have the good fortune while at that firm will be able to participate in many of these forums and get a sense for where all the different moving parts are and who’s shaping what aspects of our sector. The Leap methodology is a slightly different piece of it. That’s really more focused on taking ideas and using a practical methodology to bring them to life. So if you’re tracking what’s happening in your industry, anywhere from ten to about $30 billion a year of investor capital is going into digital health funding and healthcare annually. It was pretty low in 2023, but it’s been averaging around 20 to 25 billion a year. And even in spite of that, when you look at the number of M&A deals and the number of startups that actually are able to secure funding, there aren’t that many. Not every good idea gets investment, and not every good idea that gets investment has the resources and the talent to translate that into a pragmatic reality. So Leap really came about as an opportunity to take ideas from not just the startup world, but even incumbents, corporations that have a hard time innovating within the traditional rails of their organization and giving them the talent and operator team and focused resources and capacity to take ideas, incubate them, and turn them into going concerns in an accelerated methodology. The other benefit of that methodology, and here I’m feel like I’m doing a commercial copy now, but the …

Martin Cody: By the way, McKinsey, not a paid sponsor, but I’m not opposed.

Srinivas Velamoor: If you’re listening to kids, Yannick Martin’s looking healthier. But yeah, I think the other aspect of the methodology is this notion of build, operate, and transfer, recognizing that you may start and incubate the idea, but eventually it needs to get handed back to its owners. So part of that methodology is actually bringing resources along for the organizations they work with, and allowing them to take things over with things of velocity.

Martin Cody: Let’s take, let’s extend that, because you’re talking about that they have a methodology for scaling businesses, scaling ideas. And there’s a certain methodology. And this is contextually related to, I believe, your arrival at NextGen. So you come into NextGen and you have a lot of wisdom, but you also are looking at an organization that has a great product mix, has a great culture, has tremendous people, and there’s seriously corporate goals and things of that nature. So how did you take all of your background and everything from the engineering from McKinsey, to address the challenges immediately at NextGen? And what were you tasked to do upon arrival?

Srinivas Velamoor: So my role upon arriving in NextGen was really to catalyze growth. And as a public company that was really growing in the low single digits at that time. There was a desire from investors that had been part of the growth journey of NextGen for some of them for 30, 40 years, to want to see it step up to what they perceived as the new health care that was emerging. And it’s a nebulous role in the sense of what exactly does catalyzing growth mean? And to be perfectly honest, I had to learn what that meant to the NextGen context myself.

Martin Cody: What’d you come up with?

Srinivas Velamoor: Yeah, what’s exciting about it is you look at the organization and say, it’s like walking into a kitchen and someone asking you to prepare a gourmet meal. Your first question is, what are my ingredients and what kind of cuisine are you looking for? And what’s your taste palate? So if you were to take that metaphor, in our case, starting with who are we serving as clients and what do these customers want? What’s the North Star, first and foremost? … to NextGen because it served the outpatient ambulatory world; that’s where all the action was. So coming in with at least a base of understanding of what do ambulatory practices of the future, what are the issues that are top of mind? What are they looking for? That was the first step. Once we understood that angle of it, then the question was: How do we ensure that we serve them the dish that suits their desire for the kind of meal that they’re looking to have? And that our torture, this food metaphor here.

Martin Cody: No. And I’m going to continue it. So keep going.

Srinivas Velamoor: So we take a step back and said what ingredients do we have? And it turned out that NextGen was in this privileged position of serving almost 100,000 providers, having access to data from nearly 140 million patients over the years, empowering nearly 35% of the public health information exchange market, and privileged access to so many of the very large practices and clinics spanning 40 different clinical specialties in the industry. So looking at that base of that building blocks of ingredients, then it became a case of, okay, what do we need to, how do we bring these ingredients together in a way that solves very specific problems? And what resources do we need internally and externally to bring these together? So what that ended up becoming, in short, was a clarity of purpose. First, understanding what is the full potential of growth we could get if you were to solve these problems? We set that goal. Then we got the organization inspired and excited about believing that we had not only the privilege, but the right and the ability to get there. And that came from a lot of conversations with people all across the company, came from the addition of new talent, and it came from showing on a factual level, all the things that we had access to that were at our disposal and convincing people to believe that this was possible. And once that was done, we focused on a few simple areas. How do we monetize and unlock data for our customers? How do we take service responsiveness to the next level? How do we take things like taking friction out of a physician’s workflow on a day-to-day basis and give them 30 or 40 minutes back? So we took the macro goals and translated them into a few column moments of delight or quick wins, and then set about a very focused way, saying, let’s attack each of these things that improve the financial sustainability of a practice and improve the provider experience that makes patients happy. And if we check these three boxes, they trust your ability to take on more complex challenges and then you build, and that turbocharged the whole thing.

Martin Cody: And so then pulling that back a little bit, walking in you’re tasked with architecting this vision and then obviously selling it upstream and downstream and then implementing. Three weeks? A month? How long does this all take?

Srinivas Velamoor: We are still on the journey, is the honest answer, Martin. The initial part of, I think, shaping the vision probably took about 3 or 4 very focused months, and then sharing that vision with the whole organization in town halls, meeting our board members, meeting individually with different parts of the organization; those all took that three to 3 to 4-month period just to rally folks around, Hey, here’s the North Star, here’s what we’re working towards. And it’s taken us probably the better part of almost 18 months to 24 months now to find the right resources, in some cases, stop doing certain things, reallocate those resources, get the right people in place, and essentially implement and execute on that in a sustainable way. So that journey continues.

Martin Cody: And to extend the torturing food metaphor; you have a clientele, if you will, that you perceive their dietary habits to be one thing, but their dietary habits are changing because they are faced with and confronted with unprecedented staffing shortages, unprecedented pandemic. So you have to be agile enough to adapt and augment your offering to what you’re providing them, so that it now meets new challenges that 24 months ago you had no idea existed. How has that been progressing?

Srinivas Velamoor: It’s been progressing well. For all of the change and the disruption that’s happening in the industry, I don’t know who coined this phrase, but they said change happens at the speed of culture. And I think all of us that are in this industry look around and we see all the disruptive forces happening. But at the same time, we’re in a sector where the incentive models have been so calcified for so long that even obvious ideas that can benefit folks take a very long time to adapt. So, for better or worse, I think we’ve had the opportunity to engage our clients to say, Hey, how are your dietary preferences changing? But having also, in some ways, the luxury of more time than you normally would have expected to ensure things get adopted. Now, of course, there are extraneous forces. A great example of this is telehealth. It was kicking around in the industry for 12, 15 years, but it wasn’t until the pandemic happened where a whole bunch of incentive structures changed that everyone just said, Hey, this is obvious. We should be using it. Let’s do it. And that …

Martin Cody: The single greatest outcome of, one of the single greatest outcomes of the pandemic was the 10 to 15-year acceleration of telehealth.

Srinivas Velamoor: And that was fantastic. Now, if you look at the other big things today, cloud adoption as a way to essentially improve agility and the relative resilience of the entire infrastructure that health care runs on; that is continuing but the pace of adoption has been steady. It hasn’t been like what we saw with the telehealth world. And AI is the same thing. We’re seeing the early adopters fight of folks using these things. But at the same time, when you actually sit down and talk with physician groups, they actually say, AI is terrific, but we need to retrain our physicians. We need to reimagine our workflows and processes. A whole lot of re-engineering of the practice needs to occur before we can unlock security, and ultimately the full value of AI. So not only are we engaging our clients in these discussions, but we have the ability to be on-site with them and walk through the implications of adopting all of these technologies, and that buys us the appropriate time to make the architectural changes and the re-engineering that’s needed to deploy all these new tools.

Martin Cody: Very impressive. And two things. You mentioned the word client. I’ll come back to that in a second. But you also mentioned health information exchange and HIE that might also have to be something we put a definition in the liner notes, because it was a very big buzzword for a while. And then seemingly, I don’t know if it was a regulatory pressures or what happened or lack of adoption, but it’s a big part of the healthcare industry and the whole care delivery aspect. Talk to us a little bit about what you do from a NextGen perspective, and how that’s near and dear to the product offering.

Srinivas Velamoor: Yeah, absolutely. So we support, health information exchange is one of the vehicles by which we’re solving interoperability for the industry as a whole. So we talked about this notion of calcified incentives just now Information asymmetry in healthcare continues to be one of our biggest challenges. It shows up in things like 30%-40% price dispersion for the same service, with the same hospitals across the street from each other. Our inability as consumers to understand what the true cost of care is, inability of physicians to exchange clinical data with each other because they’re using privacy and other concerns like that as a means for making it harder for data to flow freely between all the different constituents. And of course, payers and providers are on opposite ends of the negotiating table, and having fully transparent access to data between those parties could disadvantage one or the other party in their network negotiations. So everybody lost data exchange and wants it. But at the same time, the incentive structures don’t permit full transparency. But everyone also agrees that better data sharing improves outcomes and it’s better for patients and providers. So the government, of course, this journey has been going on for 20 years. The federal government has funded many health information network initiatives over the years. And in fact, the private health information exchange market was projected to be a multi-billion dollar opportunity as recently as 15 years ago, and within the span of six years, it collapsed entirely with every one of these private HIEs getting either acquired by a payer or a hospital, or a provider system. All we have left at this point are state-based information networks or federal public HIEs that span multiple states. It’s a long answer to your question, but NextGen is actually now supporting these HIEs that have survived in the public realm. And we provide the rails for data exchange to occur across these public health information exchanges. And the same issues that plague the private HIEs plague the public HIEs as well. They’re relying on members, they’re relying on subsidies. They’re relying on the ability to create new business models, to stay and continue to provide the services that they do. But unless all the participating members freely allow the use of that data that’s going across these networks to solve additional problems and to pay and subscribe to analytics that are associated with those, for instance, benchmarking quality for all the members or providing access to those data sets to support clinical research. These are ways in which HIEs can monetize the data flowing over their networks, but only if their members allow it. So today, NextGen actually supports the rails in the backbone. We also provide solutions for these HIEs to aggregate the data. But we’re waiting on the guys and their members to permit them and us to take that data and take it to the network.

Martin Cody: And so what does that permission look like?

Srinivas Velamoor: It could take many forms. The simplest version of it could be don’t identify my unique data sets, but simply just benchmark all the participants and tell me where I rank relative to everybody. Or it could simply just be give me a report card on how I’m doing across these key measures, and I will permit you to go run those analysis and create those analytics packages.

Martin Cody: And grab these data sources.

Srinivas Velamoor: Grab these data sources and so on. As soon as you start to go into a situation where the provider of these services as for-profit entities in some cases are starting to make money, that’s when the permissioning and the consulting problem becomes a little trickier, because people want a share of the action. It doesn’t mean that it can’t be done. In fact, one of our HIEs recently signed a deal with several constituent provider organizations in their state to say, Let’s actually start a research library because all the data is in our network anyway; why don’t we make this data available to pharma life sciences companies so they could come in and do matching and find patients and studies and whatever the stipends are that are generated from participating in these studies could get them shared back with the providers and the participating patient? So that’s a win situation where everybody wins.

Martin Cody: Absoluetly. Is there a part of your job that is less appealing and exciting than the others?

Srinivas Velamoor: Short answer is no. And that’s largely because I’m a sucker for learning. There is, every aspect of what I do on a day-to-day basis is teaching me something that I didn’t know before. Nobody learns what they need to learn in college or in business school in its entirety. And the opportunity to be on the ground with clients every day looking at new problems that emerge, yes, it’s stressful and painful in the moment, I’m not going to lie. But at the same time you say, Hey, didn’t think about that. There’s something really interesting that never occurred to me. I’ll give you an example. When I joined NextGen Healthcare in the early weeks, the company was still public at that time, was traded on Nasdaq, and was in the middle of a proxy contest that had been initiated by some board members. Now, you could go your entire business career in a private or public company and never be in the middle of a proxy contest. They are no fun. You get a PhD in corporate governance and learning how these dynamics take shape between the analyst community, the shareholders, the institutional two board members, and the organization.

Martin Cody: It’s better to be a fly on the wall than an active participant.

Srinivas Velamoor: Tremendous learning. And that’s just one example of something new that comes up every day, where you have to take a step back and go, yeah, this is no fun, but it’s actually making me a better you.

Martin Cody: Yeah, that is fascinating. And it’s a lesson that you hadn’t, there was probably no check in that box that says, I want to learn about this from a proxy battle standpoint.

Srinivas Velamoor: Most of us don’t even know what it is that we’re asking for when we show up in these situations.

Martin Cody: But you bring up a good point that for the better part of the last 50, 60 years, NextGen was a publicly traded company. And last September it was acquired by Private Equity. Thoma Bravo acquired the company. And so you’re going on what, eight and a half months now underneath PE ownership. And I’d be curious, what do the front-line workers feel from that transformation on something that they experienced all their lives if they’d been there for any length of time to now, a complete flip of the switch and all of the dynamics that change with that? How has that been transferred into the front-line employees and what do they think of it?

Srinivas Velamoor: That’s a terrific question. If you ask folks today, they’d say they’re incredibly excited in one word. If you ask them eight months ago when this deal was announced, first reaction would have been fear. And it’s largely because you could take the positive angle and the less positive angle to what it means to be privately owned. But I think one of the wonderful things that private ownership brings to organizations that have been public like us for a long time, is it forces you to rethink everything. We really have to take a step back and press the big reset button and say, If you were to hang our hats on extreme transparency, accountability for performance, and agility, how would we reconstitute this company? How would we redo our processes? How would we restructure the org? How would we change our own roles as leaders in order to check those boxes? And it forces you into very uncomfortable places. And there’s a phrase we share very early on with our colleagues to say, Let’s embrace this, right? We’re going from being a public company with a million investors to, in many ways, becoming an investment for somebody. And when you think of yourself not as a company, but as an investment, it’s a completely different paradigm, a different mindset. And we encouraged everyone and said, We’re not going to sugarcoat this. Let’s all get comfortable being uncomfortable. And when you’re comfortable being uncomfortable, that’s when the real creativity kicks in. That’s when every idea has a voice. That’s when we’re breaking the silos and all the lines between managers and colleagues saying, If your idea moves the needle on one of these objectives, it’s a great idea and you get a reward. We’re not going through normal hierarchies. And it took a while for people to believe that was really what would happen on the other side of this. But fast forward eight months ahead, and they’ve seen pretty much a good chunk of the executive team turnover. They’ve seen the company reorganize, they’ve seen us have a record quarter and a record year this past year. And they’re seeing all these changes actually take hold. And now everyone feels they have agency to actually move the company in a different direction. And that excitement, I think, is kicking in for all the folks that are here.

Martin Cody: It’s interesting you say that because I completely agree with that phenomenon or that philosophy or that strategy of get comfortable being uncomfortable. And I don’t care if you’re talking about, let’s continue to butcher the food analogy. If you’re an entry-level chef and you get thrown into a situation that is above your skill set, it’s going to be uncomfortable. But the only way you can grow is to get outside of your comfort zone. And by definition, that’s going to be uncomfortable. So when you embrace it as an investment, you’re right: you behave differently because it’s no longer just a company; it’s a company that someone wants to invest in. It’s a company that someone potentially wants to acquire. And so you work a little harder. You shine things that may not have been dusted off in years and that sort of stuff. And then pretty soon, the residue of all that work shows up in success. And I think Thomas Edison famously said, Success comes before work in only one area: the dictionary. And that’s it. You’ve got to work your tail off. And it sounds like that philosophy from the senior leadership team has been adopted and is being put into action for the last eight months.

Srinivas Velamoor: No. 100%. And as an executive team and a leadership team, you have to lead by example. And we are eating our own dog food, if you will, in this regard. So I think.

Martin Cody: And there’s where the cooking analogy went off the rails.

Srinivas Velamoor: There as well. To your point, right? I don’t know if you’ve ever seen this great show on Bravo that I used to watch called Chopped. I don’t know if they still have it on or not. You get these mystery ingredients in the kitchen. You’re supposed to cook up something delicious with it. And there’s a clock ticking. In many ways operating in this world is similar to that. There’s a target. There’s a set time. There’s an investment horizon. You’ve got the ingredients and you’ve just got to figure it out. And those who can’t figure it out, they don’t stick around, right? They move on other environments that are more suited to their temperament. And that’s a little bit of what happens. You get a self-selection as well, from people that really thrive in this type of fast-paced, you know, high creativity, performance-oriented culture. And pretty soon you get enough of a bolus of those folks working with you after all the transitions happening, that it just takes on life also.

Martin Cody: And that life, I think, would be one of the more difficult areas to project, but also one of the more transformative, rewarding experiences because you start to see people rise that were pretty stagnant, but now they’re given a new environment with which to flourish in, and they take to it like, you know, a fish to water, so to speak, and they start producing things that many people may have thought they weren’t capable of, and they just loved the new environment. And boy, what a positive and pleasant surprise those individuals are.

Srinivas Velamoor: That’s probably one of the most fun parts of the job, seeing all these folks step up. They have a voice now. They’re showing up, they’re energized, they want to deliver results, and they feel unshackled from whatever it was that was holding them back. And I’m no longer in the tooth now, but I still remember being in my 20s, being that hungry guy that was just dying for a chance to show what I can do. And I think providing those platforms and forums for people to come be the best version of themselves. That’s really fun …

Martin Cody: And I think fundamentally that’s a great thing for people to keep in mind. If you create the environment as leaders and walk the walk as you mentioned, to do it yourself, those folks will self-select and start producing. If you stifle them and handcuff them and paralyze them, then it’s also going to have an equally disproportionate effect on the organization, and not in a good way.

Srinivas Velamoor: Yeah, every organization has these superstars that are just lying in wait for what? I don’t know, in many cases, it’s different in every situation. But everyone has these superstars. And if you’re lucky enough to be able to find them and give them a chance to do something, give me a fun ride.

Martin Cody: Interesting. I want to pull on something that a second with regards to development. And looking at it from your lens, you have operations, obviously, you’re probably in some way dotted line or direct line over product and strategy go-to market. There’s operations. You mentioned governance earlier. There’s always a need for capital, those sorts of things. And obviously, we just talked a little bit about people. So of those core disciplines, is there any one that’s more important than the others?

Srinivas Velamoor: I wouldn’t say any one is more important than the others. So my personal learning and everyone has a different opinion on it. I think aligning on the mission parameters is probably the most important. Whether you call that strategy or agenda setting or however that you do it, that is probably the hardest thing. In many ways, it’s like getting people to all row at the same time, in the same direction, at the same pace. Every one of those oars is important in its own way. But if they’re all paddling furiously at different rates because each one believes it’s more important than the other, you’re going nowhere. You spin in a circle. So wherever it is, that vision setting happens where we say, Hey, our mission is X. We joke in our company several times, I tell people, I’m not going to tell you how to do your job. I’m going to tell you that we need to get to Australia in 12 months. You could take trains, planes, automobiles, or parachute; you figure out the most creative way to get there and how to partner with all the parties over here to arrive at that destination. But if I don’t tell them that’s the destination, those are the mission parameters, then it’s going to be hard for them to be effective as well. So that probably I’d say is the most important part if you have to choose one. But functional disciplines all need to go hand-in-hand and work simultaneously.

Martin Cody: Perfect. I like it, and I like the way you talked about mission alignment. And it gets back to what you referred to earlier as it relates to the North Star. And I’m curious, did you ever have any scenarios where you were thinking late at night, Well, our North Star is shifting; this is not as easy or as strategically advantageous as I had hoped, and it’s taken us a while to get there without any episodes of doubt?

Srinivas Velamoor: There are always episodes of doubt. I think if you’re not questioning yourself as a leader and challenging your own assumptions daily, you’re not doing your job. That said, I think you have to recognize that when organizations like ours, for instance, that have been around 50 years, they have endured because there is a resilience to the mission and the vision that was chosen. You can tweak it on the edges, but you don’t fundamentally be … Now in our case, we said better healthcare outcomes for all is our mission. That’s the North Star. There are a lot of things that are happening in the industry that could change, but at the end of the day, if everyone in the company wakes up and says, Yep, I can wrap my head around the fact that we need to improve clinical quality, improve patient experience, support the financial sustainability independent practices, you can find a way to use the trends and the tools of today to hew to that mission. Now, I think the identity and the, or rather, where I think the Dao comes in is if you start questioning the identity of the organization. And that’s where I think there’s room for some recalibration. So you could look at your organization and say, We are a service provider or we are a technology provider, or we take accountability and risk for outcomes in the underwriting decisions. And those are choices that I think could shift and that you need to be very thoughtful about what it means for you as an organization to make those. But I think your mission and vision are, they tend to be pretty enduring, and they should not shift just because the market dynamics.

Martin Cody: They should not be right. They should not be easily alterable. Perfect. All right. We’re going to move on to everybody’s favorite round: the speed round of word association. Now interestingly enough I write these ahead of the show. The staff gives me ideas and stuff like that. I’m joking. There’s no staff. Maybe McKenzie can help with that, but I did not know we were going to have a belabored food analogy. So there’s some food-related questions here, but I’m going to say a word or a phrase, and then you tell me the first thing that pops into your head. Boston Consulting Group.

Srinivas Velamoor: Rival.

Martin Cody: All right. And this one is interesting based upon your early years. Favorite city to visit worldwide?

Srinivas Velamoor: Sydney, Australia.

Martin Cody: And why?

Srinivas Velamoor: Great combination of people, culture, food, Hunter Valley wines, and the ability to do outdoor activities. Opera House is stunning, and anyone can go out and jump on a beautiful yacht and enjoy the city from either the water or the beaches or inland.

Martin Cody: Yeah, that’s fairly idyllic. Sign me up. Now your favorite can’t miss, must-have meal.

Srinivas Velamoor: My mom’s cooking. To this day. I visit her in Seattle. She plans A 7, 8-course meal, and I come back at least 30 pounds heavier. If I’m anywhere in the world and she’s around, that’s the … meal.

Martin Cody: Okay, speaking of good eating and undervalued wines, if there is someone in healthcare, living or deceased that you would like to sit down with and break bread and maybe have your mom cater the meal, who is that person and what are you drinking?

Srinivas Velamoor: I’ve been thinking about Mark Cuban a lot lately. Random guy. I was scratching my head, thinking of all the folks that are in health care who would be a fun conversation. I come to him for a reason. He hasn’t grown up in our industry, but he’s got some very interesting and provocative ideas of how he wants to attack the status quo. And he’s not just pontificating either. I think the successful launch of Costplus drugs and some of his thesis around what’s happening with PBMs, he had some other interesting ideas about essentially funding medical school for every graduate in return for some kind of years of primary care service and addressing underserved communities around the country. So he’s got lots of interesting and provocative ideas and the means to actually incubate some of these and come at them. So it’d be fun to sit down with him and talk about it.

Martin Cody: That would be an awesome conversation. And you’re right. And he comes to the disruption angle naturally. And even his acquisition of Broadcast.com just to watch or listen to IU basketball games 30 or 40 years ago. And then everything he’s done with Shark Tank and even his innovation with the Dallas Mavericks and some of the things he did do incorporate the fans more into the games and that sort of stuff. That now people see that today and it’s just standard operating procedure. It wasn’t always like that at professional basketball games.

Srinivas Velamoor: That’s true. Not to mention it just seems like a fun guy to be around.

Martin Cody: Exactly. Completely agree. Sri, this has been a blast and we’re indebted for your knowledge and your time. So thank you so much for sharing and joining us here on the Edge of Healthcare.

Srinivas Velamoor: I appreciate that, Martin. You didn’t ask me about the wine. A beautiful …

Martin Cody: What are you drinking?

Srinivas Velamoor: Oh, we’re drinking.

Martin Cody: You’re drinking a bottle of Cabernet?

Srinivas Velamoor: Cabernet from Pride Mountain.

Martin Cody: Ah, the Pride Mountain family will love it. Perfect. I appreciate that, wonderful venue. Sri, thanks so much and I will be in touch soon. Appreciate the time today.

Srinivas Velamoor: Likewise. Thanks, Martin. Fun conversation. Take care.

Martin Cody: Cheers.

Martin Cody: Thanks for diving into the Edge of Healthcare with us today. I hope these insights will fuel your journey in healthcare leadership. For more details, show notes, and ways to stay plugged into the conversation, head over to MadaketHealth.com. Until next time, stay ahead of the curve with the Edge of Healthcare, where lessons from leaders are always within reach. Take care of yourselves, and keep pushing the boundaries of healthcare innovation.