Operational clarity in behavioral health practices with Justin Shuman

Dan King: [0:00] Hello, everyone. I am very much looking forward to a conversation with my friend, Dan King: [0:05] Justin Shuman. He wears a number of hats. His biggest one is that he is the chief commercial officer for HealtheMed. He does some consulting on the side, behavioral health kind of growth and operational strategy consulting. I should also disclose he is on the Fireside Advisory Board. Justin, welcome. You're not wearing any hats today, but you're a man who can wear many hats. Justin Shuman: [0:27] Thank you, Dan, for having me on. And yeah, I've been known to wear a number of hats. I'm in the process of trying to wear fewer hats these days. My primary hat is at HealthyMed as the chief commercial officer, but have really enjoyed both participating in what you're building, as well as supporting the growth and operational strategy of a handful of practices Justin Shuman: [0:52] over the last year and a half, two years. Dan King: [0:54] We'd love to hear a little bit about your personal journey and what has drawn you to work with behavioral health practices. Why don't we start there? Justin Shuman: [1:02] Yeah, absolutely. So we'll rewind kind of way back. Seven years ago is when I started diving into talk therapy and have been a patient client with EMDR and somatic experiencing and psycho drama. A number of modalities are just really, really beautiful and helpful for people who are encountering a wide spectrum of life experiences and just need support. Yeah. I'd say in 2024, I just had this realization. I was walking through a time where I had just been diagnosed with a cardiac condition. I had separated from an employer at the time. I lost my grandmother. There was a lot of turmoil in my life. And I just felt a sense of being called to support the very industry that was supporting me, at least emotionally, but didn't feel called to become a therapist. I have a lot of respect for LPCs and LCSWs. And one way I felt like I could really invest my giftings in business was to support informally and formally practices. Justin Shuman: [2:09] That's my journey to the space. Dan King: [2:11] Nice, nice. So what are the, if you were to reflect on some of the highest leverage ways that you've been able to support practices, what immediately comes up for you? Justin Shuman: [2:20] The highest leverage place is just having a lens that most or many therapy practice owners don't have. Therapy practice owners are wonderful individuals. They've been trained clinically. They deeply care about, most of them deeply care about clinical protocols and their clients. They're not often the most business savvy, let's do things economically efficient. And so the biggest opportunities I often see are just plain blocking and tackling and teaching stories or lessons around unit economics. Here's what you gain per session based on payer, if you're a private pay practice, sessions, assessments, here's what goes out for your staff and really help them sharpen the pencil on how to be thoughtful about kind of stewarding financial resources to grow faster. So sometimes that looks like, hey, we're going to hire three postdoc students, helping them understand, okay, how quickly can we ramp them so that they're paying for themselves quickly and not a drag financially on resources of the practice? Do we hire two in the third a few months after? Just those kind of blocking and tackling decisions has tended to be one of the bigger opportunities when I've engaged with practices formally or involved. Dan King: [3:45] There's a wide range. It's interesting to reflect on the different possibilities in unit economics in our world because a postdoc is not going to be the same as a licensed clinician, not going to be the same as a psychiatrist, right? The unit economics can vary relatively substantially. And then there's what each individual can produce on average, and then there's what different payers can provide. So there's really a lot of different possibilities there. Justin Shuman: [4:08] For sure. The other area that's just really pragmatic that some practice have, it's a spectrum of sophistication that I've seen in practices around. Inquiry analytics or outreach from patients for assessments or therapy and conversion. Like many practices I've seen, don't know what channels leads are coming from, don't have sophisticated operational focus on their psychology today footprint, don't know the basics around updating those profiles at least once a month that remain at the top of the algorithm. And so, yeah, a lot of these just basic blocking and tackling lessons, it brings me a lot of joy to share with folks. Dan King: [4:55] Are there very basic recommendations that even we could give folks now? I know it's easier when we have someone who's right in front of us, we can look at their unoptimized Psychology Today profiles. But are there some basic thoughts that come to mind that anyone listening could implement immediately? Justin Shuman: [5:09] Yeah, so the first thing to any owner or operator that uses simple practice is, where possible, separate out the services so that you can report on revenue and units right out of simple practice in the reporting. What I've seen often is that you have various business lines, various services, and visibility is lacking. And you can't really manage what you can't measure and what you don't have sight to. And so that's usually one of the first pushes I make to any owner is get in simple practice, separate out so you can see how revenue is ebbing and flowing. You can see how units are ebbing and flowing. That's the most pragmatic thing that anyone operating could do and really should do. Dan King: [5:56] I can also relate if some of the discussion about measurement is someone that sometimes can be a little math phobic, which is strange for someone who runs an investment firm. Earlier in my career, there were moments where I realized I really did need to measure something, but I was scared to see the results right. And so there can be some fear sometimes if we're building systems in our business for the first time. And subconsciously, we're a little scared about what we might learn. And being with that fear is such an important part of business ownership because Dan King: [6:25] that transparency really can set you free. Justin Shuman: [6:27] Yeah, I'm glad that you kind of pointed that out because this is a really sensitive topic around therapy practices. There's a lot of private equity dollars that for the last five or six years have been poured into practices and therapists haven't on the whole been treated particularly well. And so there's real sensitivity around the word efficiency, the word optimization, measuring things. And I think with anyone that I've talked to and worked with, I try and just name that and give it space and reinforce, hey, you don't have to do all the measurement changes at once. But for the longevity of your practice and the health of your practice, you can do this in a way that's kind to the humans that support your practice. You can do this in a way that doesn't turn down the screws on people. You can do it at first just to know. You don't have to make any decisions based on the data. Justin Shuman: [7:29] Until you feel ready to do so. Dan King: [7:32] It is interesting. I know from my vantage point, and I suspect you've seen the same from yours, Justin, that we're in this interesting moment where sometimes these cultures that have struggled together can benefit and learn from each other in so many ways. So from my perch, I see investors interacting with clinicians and clinician owners, and there's so much benefit I see from building partnerships between them. If you're working with ethical people that are well-intentioned and ultimately sort of appreciate that they may speak different languages and bridge building between those two worlds is a point of pride for me. And I don't lose sight of how challenging it can be because folks that come from different worlds do speak different languages. And it is so easy for there to be misunderstanding. Justin Shuman: [8:21] Yeah, I couldn't have said but for myself, I think patience and allowing people to come along and process the language difference and bridge. And the bridge goes both ways. I mean, I tell clinician owners all the time, like, I'm learning. You see the world through the lens that you've been trained to see the world through. And it's a beautiful thing because I, as a non-clinician, learn. As I've said before, it gives me great joy that I've been financially financially or operationally or business trained and view the world through that lens and to, Having spent so many years as a client in therapy, I feel like I've got the tools to bring the business perspective in a tempered way that is minimally off-putting. I love it. I'm going to borrow that. Minimally off-putting. Yeah, I don't want to say that everything I say lands as I intend it all the time. I make mistakes and misstep. But I'm really sensitive around the language that I use when I work with folks that are running these practices. Dan King: [9:29] I had a very interesting email exchange this morning with a practice owner who he runs a relatively substantial practice and 80% of his revenue comes from one payer. This was always sort of... Something he was concerned about, and he's been attempting to sell his practice for some time. And, you know, I wanted to have a conversation with him where I gave him a realistic sense of whether he could sell his business and what he could potentially get for it. And he knew that this was an issue. He hadn't really named it. And we were joking that this term, payer concentration, is thrown around so often, right? Justin Shuman: [10:06] Right. Dan King: [10:07] Yeah. Insurance companies have their own language. In this world of behavioral health, investors speak their language, lawyers speak a certain language, clinicians speak their language, insurers speak yet another language. And so there is something essential about bridge building, not just between investors and clinicians, but between clinicians and insurers with lawyers, right, who are in many cases attempting to protect practices from regulatory missteps. And it's very, very challenging to sort of maneuver between these worlds. The easiest thing to do is to rely exclusively on others who specialize in those domains. And yet, when we're running practices, my experience is at least you don't have to necessarily be fluent, but to be curious about where people are coming from in these different worlds, to be curious about getting at least to a basic level in each of these languages, I think can really be of service to every stakeholder. Justin Shuman: [11:04] Yeah, that can't be stated highly enough. I think what I often say is you don't have to like the perspective of the various stakeholders in the ecosystem. However, understanding them allows you to steward or shepherd your business in a way that is at least informed than completely dismissing and saying, for one reason or another, I don't like that stakeholder. I don't like the payers or the insurance and the way they treat me. I think when you step into their shoes, and as someone who has sold to payers for over a decade, I have my fair share of critique and constructive feedback. It doesn't always help, though. You still have to, if you're in their sandbox, you have to at least respect their vantage point because you can yell into the void for as long as you want. They hold the purse strings for a lot of the revenue in the behavioral health space. Dan King: [12:07] Oh, yes. And there's all kinds of interesting areas we can go when it comes to payers. But I would be curious to zoom in a little bit on your diversity and experience. So you come from business training, you've been dealing with payers, and you've been a patient yourself. And you've indicated that you benefited from your behavioral health patient experience. was it natural for you to learn that behavioral health language or were there specific things you did in order to start to become familiar with it? Justin Shuman: [12:37] When you come to the behavioral health space, at least as a client or a patient, sometimes it's, how do I want to frame this? Yeah, sometimes you're kind of like forced there. I didn't have the vernacular and I learned a lot in those formative years in therapy. I would say for me, the walk has just softened, maybe some jagged edges. The experience, I think journey gets overused, but the walk through... Uh therapy over the years has just planted the seed for compassion not only personally in my life but professionally that has grown in the in the near decade of of work but yeah to answer your question directly i most of the language i use now was a hundred percent forward to me in those early days well thank you for speaking. Dan King: [13:29] It and delving so deep into that world it is so Justin Shuman: [13:33] Rare it's. Dan King: [13:34] So rare for people with the hard business training to do and you know I've experienced myself how delving into that world can soften the harder edges can open you to so many beautiful possibilities I know you bring that to your work and it's it's just so beautiful to be with I can feel energetically how tender that is and thank you for going there Justin Shuman: [13:54] Yeah I think um you know I to get emotional about it mostly because it's an unlock and the emotion comes from like a super happy and like grateful place and i don't use that word carelessly i think grateful is another word that gets overused but the power of knowing oneself the power of being able to like map that to behavior, gives people the cheat code, the unlock, to really transform. And transform can look different for a variety of people. For some, it can be being a better partner, a better spouse, a better friend. And it can be all those things and being a better leader for your team, being a better acquisition pursuer in your world. Justin Shuman: [14:48] It's just knowing oneself is an unlock that's multifaceted. At least that's been my experience. And the journey continues, man. It's a lifelong commitment. And I'm so glad that I put myself on that path. Dan King: [15:01] What are you talking about? I think it ended last Tuesday at tea time. We all have earned as much self-awareness as we possibly can. Justin Shuman: [15:07] Yeah, yeah. I've arrived. No more work to do. Dan King: [15:12] It's interesting how I'm reflecting on, and thank you again for saying all of that. It's lovely. And I couldn't agree more. And I'm reflecting on how much of our work since the pandemic has been virtual. And I can remember feeling different about business when the pandemic hit and all of a sudden we were all on Zoom all the time. Right. And there's this way in which this sterility, right, of force that is at the core of how so much business is done. You can kind of feel it. Right. Justin Shuman: [15:42] Yeah. Dan King: [15:43] It's amazing how I feel, having delved into some of the same worlds you delve into, how even the experience of a Zoom call feels so much less sterile. It feels so much more human, right? I can feel you as you go to a tender place. And I'm so grateful to be able to feel that because it's color in what would otherwise be, you know, a day of freaking spreadsheets, which I've yet to find a way to make those more colorful. Justin Shuman: [16:07] Yeah. Other than by aging the color. Dan King: [16:11] In a cell, but the human texture, especially in a virtual remote only world Dan King: [16:17] has is so lacking so much of the time. And so to be able to add this level of vibrance is such a gift, because we just spend so much time working. Justin Shuman: [16:27] We do. I mean, I think my average calendar looks like five to six hours a day of Zoom meetings. And, you know, I cherish the ones that are like this. And I have probably a handful per day that are... A mix of, you know, even with the colleagues at HealthyMed, is a mix of checking in on one another, being real humans. I don't think the workplace is family. I think, you know, healthy boundaries exist, and we can care for each other in a way that's a little bit more than professional. And we get great work done. And somehow we've, when you're with the right team of folks, that can happen. I've been in other scenarios, contexts, where that isn't the case. And being on another Zoom call, a sterile Zoom call, can be not great for the nervous system. Dan King: [17:21] Absolutely. Our perpetual, it's interesting, you're calling me to this interesting reflective space where I'm just even thinking about previous experiences today. And I'm thinking about how much force and an energy of rush is so associated with so many of our meetings. And just the simple act of in the moment, just for a little bit, slowing down can seem so antithetical to that energy of go, go, go. It needs to be done immediately. And in our world, in the acquisition world, there's so many different, so many, there's the old expression that time kills deals. yet I can't help Dan King: [18:03] thinking that the work would actually get done faster if we could feel each other. Justin Shuman: [18:09] This is the tale of two truths can be true at the same time or two things can be true at the same time which is a paradox I have struggled to internalize to say it out loud often because we need to be intentional with moving forward and we have to be present at the same time and it looks different moment to moment, meeting to meeting. This dialogue brings to light something that happened earlier this week. I lead... Our Tuesday morning management stand-ups. And I'll admit, I'll name it, I can tend to be a taskmaster. I have an agenda. I want to run through it. But one standing thing on the agenda is highlights, call-outs, gratefulness for last week. And this Tuesday morning was a particularly full agenda. But we had an executive team member that had a granddaughter with a really impactful surgery, a scary surgery, and this person shared about it. And it just felt in the moment like as much as I historically have wanted to rush and been like, we're just going to nix the gratefulness stuff on the heels of this vulnerable update from this leader on our team. It just felt in that moment like, no, we're not skipping gratefulness today. Justin Shuman: [19:32] We'll squeeze the time out of some of the agenda elsewhere, like on the heels of some heavy, emotionally heavy news and vulnerability. I just wanted to support the group with kind of gratefulness coming out of that. Dan King: [19:45] So love that. I certainly can't pretend I understand how it all works, but at some level, when people can really come together, when they're bringing, there's no attempt to impress, they're just bringing who they truly are to the moment. I think it energetically fuels business, right not necessarily in a go-go way but in this richer in this richer sense that we are truly invested in what we're building Justin Shuman: [20:09] Yeah, yeah. And don't get it twisted. Like this is not we're not doing trust balls here. We're what we're doing is creating a safe container. And the highlights are business oriented. But it's it's calling out, hey, this person leaned in last week and did stuff well outside of their job definition and scope for the betterment of the team and our clients. And we just want to acknowledge it and shine light on it. And, you know, when the team feels safe, the team feels motivated. That science is well-worn, and I think we as a society would be more efficient Justin Shuman: [20:46] if we could create more safety in our organizations. Dan King: [20:49] Could not agree more. As we come towards the end of our time here, are there any kind of last words of wisdom that pop up from where we've landed here? Anything else you'd want to share with behavioral health practice owners that's relevant? Justin Shuman: [21:02] I think what I would want to leave them with is going back to what we hit on earlier in our conversation, like building systems to be able to see the inner workings of your practice and doing that at a pace that feels comfortable is important to do regardless of what your end goal is. So your goal might be to grow and never sell your goal may be to sell in a in three or four a year then you should absolutely be doing this to build the story that will resonate with acquirers but doing the work of understanding your business on a detailed level is parallel it's the same work that you would do as a client in therapy and it's it's worthwhile work there you go there you go It's worthwhile work. Just like therapy, doing it at a pace that feels resonant and where you can integrate the learnings is the most important thing. Dan King: [22:03] Maybe just to put a point on it, how is it the same work? Justin Shuman: [22:06] Yeah, it's the same work because you're going to unearth things that you might not like. You might unearth things that are really beautiful and bring joy. And you might say, wow, those three therapists in aggregate, it was obfuscated how hard they were working. Now I can see it because they're doing 25 to 30 sessions a week. And I want to emotionally support them and like reflect back how well they're doing and acknowledge them. So the parallel is you unearth things that you want to celebrate and you unearth things that you want to intentionally change with time and practice. Dan King: [22:47] Love, love the analogy. Justin, thank you for your wisdom, your vulnerability, your openness. Beautiful, beautiful conversation. And I think people will think about it and feel it. So thank you. Justin Shuman: [22:59] My pleasure. Thanks for having me on, Dan, and grateful for the work that you and the practices that you'll lead over time are going to do, both at the practice level and for the hundreds and thousands of clients that they serve. So thank you for your work.