The Science & Soul of PT: Why the Left-Right Brain Combination is the Secret to Great Leadership

Sarina Richard (00:03):
I'm Sarina Richard, and you're listening to Therapy Matters presented by Raintree. Therapy Matters, explores the ideas and innovations reshaping rehab therapy. All right. Good morning, Brady. Thank you so much for being here.

Brady Hill (00:21):
Good morning. Thank you so much for having me. I appreciate the opportunity.

Sarina Richard (00:25):
Awesome. Well, let's first start with just your background. Tell us a little bit about how you got started in healthcare, how you got started in rehab therapy, and then also where you are at now.

Brady Hill (00:36):
Maybe I'll go in reverse order there for a little bit of background. I'm CEO of Cypress Health Partners, which really consists of Baystate Physical Therapy and MVPT. We've got about 165 clinics serving communities across Maine, New Hampshire, Massachusetts, Rhode Island, and upstate New York. And I think our core ethos organizationally is how do we try and drive meaningful change in musculoskeletal health? So how do we create a more efficient, better model for our patients, for the communities that we want to serve? And I think try to find ways to improve healthcare at large. And along that path, we have to make sure that we are a best in class provider in the quality of care that we provide the patient experience, but also the team experience. So that's really where our organization is centered. As it relates to my background, it's a little bit unique. I was not linear by any means, and if anyone knows me personally, they know I sort of love these linear plans.

(01:26):
But I started out in a very different world. I came out of school, I was in healthcare advisory, so working with entrepreneurs as it related to capital raises and strategy and growth, and eventually left that and moved into a healthcare investing group. And I think ultimately my passion coming out of school was I want to work with people that are interested in creating something. And healthcare was an area that I had spent a lot of time thinking about from a policy perspective. I ultimately think it's one of our country's biggest challenges. And so it was sort of coincidental that there was this opportunity to help build a healthcare advisory practice and to get real exposure to these exciting healthcare entrepreneurs, physicians, clinicians that were trying to create positive change. And so I got a little bit of a taste and then I said, you know what?

(02:12):
I think there's an opportunity to build deeper relationships and investing role. And I learned a ton, but I quickly realized that really wasn't what motivated me personally. It sounds a little bit trite, but I woke up one morning and said, gosh, I'm just not that excited to go into work and anyone who knows me, I'm kind of a hundred miles an hour at everything. And so to not be excited, it's very difficult. And I think you and I have talked about this before. I think one of my realizations at that point was whatever I do has to be something that I believe has real meaningful purpose. And for me, purpose is not just about growing or building something, but can it have a positive impact on my friends, my family, the communities that I live in. Some people including my family, are able to bifurcate personal life and professional life.

(03:00):
They can be very philanthropic and then do something on the side or have a professional calling that be in finance or anything else. There's nothing wrong with that, but I couldn't do that. And so I sort of had this bizarre opportunity and I got a call literally the same day and it was, would you be interested in helping to start a pediatric home healthcare company? And my mom's sister had cerebral palsy. It was very challenging for their family growing up, put a lot of stress fortunately because they had great support, my aunt is still independently living today, and it's a really cool story, but it was one of those moments where I had a very personal feel for what impact we could have and sort of the challenges that communities face. And it was an area of, it's very personal. And from a health policy perspective, I do like to try and figure out how do you create better models?

(03:54):
There was this fundamental issue, which was it was incredibly expensive to take care of pediatric patients within the healthcare setting in a health system. And the outcomes were not very good. Infection risk, behavioral health, quality of living was not good. And so we wanted to sort of build this other model. And so I left, I said goodbye to the healthcare investing world, to what was arguably a much more certain pathway and left to move into an operating role and loved it. It was very hard and challenging in a very different world, but I woke up every day feeling like if we executed on our plan, if we were committed to the right things, we could make a positive impact on people's lives.

Sarina Richard (04:30):
You could make a difference.

Brady Hill (04:32):
So that was my shift out of the advisory healthcare investor world. But the shift to PT was a little bit of a different evolution. We had done pediatric physical therapy. I had seen it firsthand. I had previously had a number of sports injuries and PT had been very helpful in my recovery. And I actually started by having a very negative experience with an orthopedic surgeon who wanted to do surgery that was not necessary. And so I could see it from both angles where there was this inefficient, ineffective care model. And yet there was this incredible solution, which was PT that changed lives and I had personally benefited from. And I got to introduce to the founder of our organization, and he and I hit it off around really this model of how do we make healthcare better and how do we create more positive impact on patients' lives, reduce the amount of opioid utilization, reduce unnecessary surgeries, get people better access to care, focus on wellness more holistically. That's not exactly the Reader's Digest version, but that's how it came to be.

Sarina Richard (05:30):
That's super inspirational. I mean, when you spend 70 to 80% of your day working, it's important that you are doing something that you love and good for you for making that change and realizing that and realizing that you wanted to make an actual difference in impact. So thank you for sharing that background. It's exceptional.

Brady Hill (05:48):
Thank you for your opportunity. I could not emphasize, I could not be thankful enough about the opportunity to work within physical therapy. I mean, not just our clinical team, but admin team are incredibly passionate, wonderful people who care so deeply about what they do. And I think having spent a lot of time in healthcare, there's a lot of cynicism. And that's not in PT. While there's frustrations, people go in every day and they change lives and they feel good about it, and they bring a type of energy that I love and I feed off of. So it's been wonderful.

Sarina Richard (06:17):
Let's switch gears and talk about acquisitions. So a different kind of acquisition. Would you consider Cypress acquisitive? And if so, how do you define whether a company is acquisitive or not?

Brady Hill (06:31):
What we try to do is we want to be very partnership focused. and we have a broader strategy around how do we create network coverage that aligned with really great quality outcomes and great patient experience is going to position us to be this larger catalyst for change in musculoskeletal healthcare. And that means that we do need to find partners in new geographies to be able to take care of. We have sort of a threshold. We want to be able to take care of 85% of the people in the states that we serve. That's how we think about it. And to do that organically would be very challenging. And we also recognize that there are great practices out there that would benefit from some of the resources that we can bring to the table. So if we can help them unlock their potential, help provide them more time or bandwidth as either practice owners to be able to focus on building their team or serving their communities more effectively, taking all the things that they didn't, no one became a PT to deal with, well, I hope not, revenue cycle management.

(07:24):
That was never something that was like, oh my gosh, I want to be a PT so I can new RCM, but if we can take some of those things off their plate, what we found is that if you find people that are really culturally aligned that are hamstrung today by some of the administrative burden associated with PT, there's a great opportunity to build an aligned organization where they benefit from our resources and we benefit from a great network and also bringing passionate, thoughtful people into our organization. And so we try to really have sort of that network benefit. And so when you say, are you acquisitive, I'd say, look, we're very interested in finding great partnerships and we're interested in finding people that share our passion for improving PT and who would benefit from the resources that we bring to the table. If we can create value for them and we can create value for the communities that they serve, and we think it can create network benefit for us. To me that's sort of a check, check, check. But admittedly that strike zone is very small.

Sarina Richard (08:17):
What is your strategy or do you have a playbook for deciding when to make an acquisition or who to acquire and would you consider yourself picky?

Brady Hill (08:28):
So we take a very top down approach. I mean, we spend a lot of time, I should say our team spends a lot of time evaluating data across the markets. And so pretty much across every market that we serve and then our contiguous markets, we know who all the physical therapy providers are in the market. And through some of the data we can see what are folks' clinical model. We spend a lot of time talking about what people care and value from a cultural perspective. We spent a lot of time trying to understand whether or not we have the same vision, mission, values. And it's funny because we've had conversations with folks over the years, and I'm sure they're not thinking about it from this perspective, but because like, oh, we didn't even know you were interested in us because you just ask us about what we're passionate about and what our biggest challenges were with our team or where do we see problems today?

(09:15):
And for us, that's actually the greatest litmus test. I mean, do we share this opportunity, this passion to be growth oriented? And the other thing I'd say is adaptability. So we think about cultural fit. One thing we take a lot of pride in is adaptability. I mean, I mentioned it a moment ago, when things evolve and change within the market, we think we have to change. And so we look to find partners that have this sense of adaptability, that are constantly looking, how can we do things differently or better, whether it's to better serve their team or their patients. So inevitably we start at the very high level.

Sarina Richard (09:44):
Yes, you start with almost an interview.

Brady Hill (09:46):
I mean, we'll start with the thousands of providers within the market and narrow it down to who are what I call priority folks that we want to get to know. And then it's more the interview and that cuts the list down pretty significantly. So we tend to have a very narrow lane in terms of the folks that we're trying to reach out and spend time with.

Sarina Richard (10:04):
And how long would you say an average acquisition or partnership creation would take for you? So you create your funnel, you have your target list from when you do your reach out to when you actually make the acquisition. What's the average length?

Brady Hill (10:19):
I would say the average is probably in the three to four year range.

Sarina Richard (10:22):
Wow, Okay.

Brady Hill (10:24):
I wouldn't say that's inclusive. There's certainly been circumstances that have moved a little bit faster, but most of the conversations that we've had have started years ago. There have been times where we probably have been a year or less, but I would say that's more the exception than the role.

Sarina Richard (10:38):
Yeah, I love it. Your theme is very right and left brain balanced where you've got the mission and the heart, but you also are very data-driven and there's one area within therapy that really benefits from both sides of the brain, and that's policy and advocacy. There's so many different areas to attack or that you could focus on when it comes to advocacy and policy. What are the biggest areas, or let's pick the one, cuz there's so many areas we could go into.

Brady Hill (11:10):
I think fundamentally there's a disconnect between how the physician fee schedule benefits patients or doesn't benefit patients and the way the physical therapy aligns and works with patients. Well, it sounds kind of esoteric and it is. I just don't think that physical therapy is well positioned to be successful in the existing fee for service model. I mean, if we think about it from an advocacy perspective, I think we see need to see really meaningful reform that stops thinking about us as, okay, we're going to get paid based on the number of units that we provide, and starts thinking about what's the long-term value that physical therapy creates for our patients. And if you look at musculoskeletal health as an industry, it's about, depending on estimates, it ranges, but I'll go low. It's about 360 billion industry, of which 20 to $25 billion is outpatient physical therapy. It's a very small component of a very large sector, but we have the opportunity to influence all that downstream cost.

(12:06):
I mean, orthopedic surgery alone is about another $25 billion. So effectively you've got $50 billion that's in direct care provision and you've got $310 billion that's in facility fees and imaging and other ancillary expenses. And in my mind, there's this tremendous opportunity for us to dramatically reduce that portion of spend. I mean, we know when we get to patients early, we get patients into PT, we focus on conservative intervention as our starting point. Not only are we able to deliver much more cost effective care, we're able to achieve much better outcomes for our patients, improve their function, improve their quality of life.

Sarina Richard (12:40):
Avoid expensive surgeries, avoid addiction to opioids, there's so many benefits.

Brady Hill (12:45):
Bingo. And so I think one of the things that we're really excited about from an advocacy perspective is how do we think about really meaningful innovation within the reimbursement model? I think reimbursement again is you can't start with reimbursement. Reimbursement's sort of the outcome of creating a really effective care model. But there's some really interesting pilots in Maryland. They've got a pilot called EQIP, which is really predicated on six month episodic care savings. So if you get patients into PT first and you're successful in avoiding downstream costs, PT actually shares in that benefit. And what they found shockingly is that they were able to save really meaningfully. And actually, and the way that it works is effectively that based on outcomes, PT then gets a percentage of that saving so as high as 50%. And so the effective impact for PT is that reimbursement changes dramatically.

(13:36):
But I think what's more important is that your team is not worried about unit coding anymore. They're worried about taking care of patients. And I kind of have jokingly used the term being their Sherpa. I mean, I think it's such a unique environment in physical therapy where you build this depth of relationship over the course of an episode of care, whether it's eight or 10 or 13 or 20 visits depending on the indication. And you build a relationship that's really differentiated where patients trust and disclose information that they otherwise wouldn't. That puts us in a profession, in a really unique position to be able to sherpa them along throughout the rest of their care. And we talk a lot about making sure that we have the broader context of the healthcare ecosystem. We need to know, look, we can't take care of everyone. There are patients that we will need to refer out, but how do we make sure that they're referred to the right person? And how in physical therapy can we help to drive really meaningful value, not just around their care pathway, but around the quality of care that we provide? There's been a lot of talk around value-based care and primary care, and it's worked in some cases and hasn't worked in some cases.

Sarina Richard (14:38):
Yeah, that BBC has been around for decades.

Brady Hill (14:40):
Without a lot of traction.

Sarina Richard (14:41):
Without traction.

Brady Hill (14:43):
And this may sound sort of counterintuitive, you need to say, wait, it hasn't worked. Why are you so excited about it? I think we're the best equipped, frankly, of anyone to provide value-based care. The challenge with primary care is they actually don't take care of many patients. The vast majority of patients are being referred out to specialties, and their value add is that they're going to help navigate them to the appropriate specialty. Those that have been really successful in value-based primary care have found a specific niche in which they want to be really, really good. So chronic care management's an area that people have been, okay, we can be really successful in managing patients with diabetes. We're in a unique position in which not only can we identify and triage patients to the right care setting, we can actually take care of them too. And so we're in this, I think the poll position as it relates to being able to create really meaningful value, make sure that we align patients to the right place, but also treat 70 or 80% of the patients that come in and by doing so dramatically improve their quality of life and reduce their cost profile.

(15:43):
So I think seeing this shift where people are thinking about reimbursement for physical therapy based on not just our time and the fee for service model, but on our ability to really meaningfully create savings downstream, I think that's huge.

Sarina Richard (15:58):
Yeah, I would agree about BBC being a great use case in therapy because if you think about the patient journey, we're at the end. So we can really monitor Sherpa as you mentioned, but also monitor the actual outcome because we are there for 8, 10, 12 visits, how many visits you have, and you can see the progression of change over those visits and you are monitoring the outcomes or the success of that therapy.

Brady Hill (16:23):
And we can track outcomes with data in a way that a lot of areas of healthcare can't. Both in terms of our patient reported outcomes, but also as it relates to objective measures. So I think we're in such a unique position to articulate our value proposition in a place that a lot of other areas can't, but I also think that's what we have to do as an industry. We have to start articulating our value. I kind of joke that the rest of healthcare has no problem articulating their value, and I won't hold that against them. I think PT has sort of the opposite complex, which is we want to be deferential, let's stop being deferential. I mean, our teams work incredibly hard every day to change patient lives. I want them to be proud of it. I want them to share their story with their patients. I want patients to be evangelists because we know based on the data, I mean our NPS score as an organization is in the mid nineties, and we have all of these evangelists out there that believe so deeply in how great PT is. We need to utilize that to our benefit as it relates to policy and to articulate the challenges that PT faces, but also the value that we can create. So I don't want to say we should be arrogant, but maybe we should be a little less humble than we are and be proud of what we create and share that message.

Sarina Richard (17:33):
So I heard a couple of ideas in there, and if you, so from changing the way we're reimbursed, maybe looking at more value-based care models, having a grassroots campaign where people are really advocating for the industry. If you plot those on a, I'm sorry, but a two by two, an impact effort matrix, what would you say would have the greatest impact? And would you focus first on something that is highest impact or least effort?

Brady Hill (18:03):
I think that a lot of what I've framed out are high effort, high impact. So I think any organization sort of has to portfolio manage how they approach change initiatives or change management as a whole. And so our organizational ethos is we are going to have a certain number of initiatives that are in that high effort, high impact cohort, and then we are going to have some that are quick wins And trying to create an effective balance, and I would say is you also have to know where your organization stands at any given time. I look at where we are today as an organization where I think we've laid a lot of great foundational components, and I want to be aggressive. I want to create change. And frankly, I think there's enough structural headwinds within physical therapy that we have to, and we have to be willing to think about innovation. We have to be able to think about real meaningful change to the way that we're reimbursed, and then we have to invest in the technologies that are going to help us do that.

Sarina Richard (18:53):
It's very mission-driven, which leads me to think about hiring and recruiting. So how do you keep people motivated about that mission when you're faced with difficulties in finding the good talent, keeping them aligned with what you're trying to accomplish, giving them a focus for the end goal? What is the end goal? How do you keep them focused on that?

Brady Hill (19:18):
So I think there's this emphasis now, especially for folks that come out of school, which is thinking 10, 15, 20 years ahead right away. And it can be overwhelming. It can feel like, I don't know how I'm going to get there. And so what we really try to do, and I'll fully admit we've still in a little bit of this from level five leadership, but really try to help people become really confident, successful individuals and team members as a foundational point and create both a career path and a set of resources in our onboarding and our mentorship programs that allow people to have a really clear sense of what success looks like and to make sure that they feel like they're making good forward progress. And then along the way, before they notice it, they've built this really robust toolbox. They understand what great clinical care looks like, what the practices that lead to great outcomes look like. And so our initial career path, our early career advancement program is really about that. It's how do you create this runway so that people feel like they've got clear wins, there's a clear sense of what success looks like. We use full objective measures as it relates to our career path.

Sarina Richard (20:18):
So you have a real defined career path with gates and levels that define how you make it to the next level. Wow.

Brady Hill (20:25):
Yeah. For us, it's PT one, PT two, PT three, senior PT.

Sarina Richard (20:29):
Can you share a little bit about what is in each of those levels?

Brady Hill (20:32):
Within our PT ones, there's a lot of focus on how do you create the right behaviors that lead to great clinical outcomes down the road? So how do you schedule effectively so we can see how are folks prescribing and then scheduling patients? We have an educational tool called our checkout checklist. So it's a part of what you do when you finish up with a patient and evaluation. You review what their expectations are, you try to set the expectations that their commitment for care, Hey, I'm going to need you to be focused on adhering to your ATP. I need you to come into your visits when you're here. I need you focused. We need to make sure that we have really good alignment between our clinical team and our patients. And it's a really strong tool that we found helps to drive plan of care adherence, and we can track whether or not people are doing that or not.

(21:13):
And so those inputs, and there's a couple others, but those inputs are where we start. Drive the right behaviors, allow people to say, wait a second, it's pretty easy for me to do 90% of this. I don't know why I wouldn't be able to do 90%. And the intent is not to create these really aggressive stretch goals for folks that are just joining our team. It's to say, I can be successful in this organization. And then we have really accelerated promotional pathways. So if they are successful in the early on, they can move from PT to a PT one to a PT two in six months. And then as they progress in their career path, it becomes less about the inputs and more about the outputs. So each level becomes a little bit more focused on, okay, what are your outcomes versus MCID? What is your NPS score?

(21:55):
And it stretches a little bit more as you go on. We don't want somebody coming right out of the box and saying, oh my gosh, we're expecting you to have an NPS score of 95 and your outcomes are going to be 80% better than MCID. That's not a strong starting point, but if you can create an environment in which we're nurturing and creating this desire for growth, we think we can be successful. And then once we've built this strong individual and this strong team member, we then think about what does long-term success look like? And what we found is that not everyone has the same motivations, not shockingly. There are folks that want to be more entrepreneurial, that want to be in management pathways that really want the opportunity to shape care in a specific community, often where they grew up. And if that's the case, we have a pathway to partnership. So you can open a clinic with us and you can be a 25% owner in a clinic. And it's really, the economic barriers are very, very small.

Sarina Richard (22:46):
So you give them a stake.

Brady Hill (22:47):
We give them a stake, and then we don't have aggressive management fees. So our partners can do really, really well financially. And if you become a partner, not only are you going to have a 25% interest in the clinic, but you have a real voice. We have partnership meetings. Partners give us feedback around what they feel the direction of the company is, what are their pain points? But we also found that not everyone wants that either. There are people that want to be amazing clinicians and want to teach. And so we've tried to create a clinical specialty pathway as well.

Sarina Richard (23:14):
It's brilliant. What I love about the step one is it's very patient focused. So are you doing the things that are going to help the patient? So you keep the focus around why you are in this profession as opposed to thinking automatically like, okay, did you check all the boxes? Did you get an A in your compliance score? Did you show up? Are you scheduling the patient for follow-up visits? Do you know why they're scheduling for follow-up visits? Are you making sure that when you're going through the plan with them, they understand what the plan is. It's very foundational. So once that becomes almost like rote knowledge, then you can build off of that. And it sounds like what you're offering your team is the sky's the limit. They could become an owner in your clinic, which is absolutely incredible. Or they could stay on a different path and stay a clinician. So you've kind of given something for everybody.

Brady Hill (24:09):
That's been the goal. I mean, I think we have probably have self-selected a lot of folks that tend to be very growth oriented, and I think it's a core value within the organization, and it's a tenant that we really focus on. And growth doesn't always have to be growth in the traditional framework. Are you becoming a better version of yourself? Are we helping you to unlock your potential? I think what we found though is that value drivers evolve over time. And we have a group today that is graduating with more debt, higher expectations, has probably had a very different experience in terms of the way they're assessed academically, the expectations that are set. They're very achievement oriented, very type A. And so rather than say they're not fitting the mold that was historical, how do we create an environment that helps them to be successful and helps to build some level of resilience as well? Because what we find is if we have passionate, resilient team members, we deliver great quality care and they help build that same resilience within our patient base.

Sarina Richard (25:01):
I love that. I love that you decided not to just continue to be part of the problem and complain, oh, they're just not working hard enough, but actually create a solution, be solution oriented. Think about what could work for this new group of PTs. That's great.

Brady Hill (25:15):
I wish we were probably faster in doing that, quite frankly. I think there was definitely probably a two year period where we just were pulling our hair out saying, okay, what needs to change? And the reality was we needed to change.

Sarina Richard (25:27):
Yeah. I think you're uniquely positioned given your, as you call it, non-linear background, to look outside of this space to get inspiration on how to run your business. And it's clear you've been very thoughtful about recruiting and hiring and career pathing, and kudos to you for that success. So to bring this full circle, thank you so much for coming here. This has been so inspirational, just hearing about your incredible trajectory in your own personal career, the decisions you made to get into this space. Some of it was accidental, but some of it was very thoughtful. And so kudos to you for really taking that. And then it's clear that you've built that same kind of thoughtfulness and mindfulness in building this business with your team and also how you're thinking about it from the broader perspective of the industry and what you can do to impact change at a broader level. If you could do anything differently, what do you think that would be?

Brady Hill (26:24):
For some context, I ask our team that every quarter. Alright, let's reflect back on the last quarter.

Sarina Richard (26:29):
Doesn't surprise me at all that you are reflective and thoughtful?

Brady Hill (26:33):
Yeah, and I think you have to be careful because hindsight's always 20/20. I think there's a couple of things that I would say internally I would've definitely done differently. I think being much more proactive four or five years ago around the work that we were doing to foster team engagement and team development. I'm really proud of what we're doing now. I wish we did it earlier. I think we could have been a little bit further down this pathway. I think there's initiatives that we're implementing now than I'm like, gosh, why didn't we not do that a year or two ago? And so I think we were a little too slow in putting that at the top of the priority list, but now I'm very confident that it's going to stay there.

Sarina Richard (27:10):
Yeah, makes sense. Well, thank you so much for your time. You're a very inspirational leader and just want to thank you very much for sharing all of this.

Brady Hill (27:18):
Well, thank you very much. Thanks for having me on. And I'd also say thank you for Raintree's partnership. We value the relationship. I want to say if you're thinking about innovating and creating change, you have to have a partner that wants to do the same things. And I know how hard you all are working to create an environment in which our therapists can focus on our patients and deliver great quality care and that makes their day easier. And at the same time, being open to new approaches, new delivery models, things that are technologically really evolving. So thank you all so much.

Sarina Richard (27:48):
We appreciate you saying that. Awesome. Alright, thanks Brady. Links to learn more about Raintree Systems and anything else mentioned on today's show are available in the show notes. To learn more, go to therapymatterspodcast.com. Follow Therapy Matters on YouTube, Apple Podcasts, Spotify, and anywhere you listen to podcasts.