Keep the Objective, Change the Strategy: A Living Approach to Planning with Mark Vorherr
Download MP3Well, hi, everyone. I'm Daniel Williams, senior editor at MGMA and host of the MGMA Podcast Network calling in from the home office today. It's just one of those days. And Today, I'm really excited about the guest you're going to get to meet. It's Mark Vorher.
Daniel Williams:He is CEO of Mayfield Brain and Spine. We're going to be talking about strategic planning, some of the processes that Mark has mastered over the years. He's going to share those with you. He's got some interesting things in his personal life we're going to get to as well. With all that said, Mark, I sure did enjoy getting to meet you in an early call and, want to welcome you to the show.
Michael Vorherr:Well, I appreciate that. I've been thinking back on when I was first introduced to MGMA, and it was 1999. Wow. And I think I think back on those days, really kinda just the start of a lot of work RVU compensation, educating me along the way. And and I've just had such a respect for the organization and its plight to make physician life as best as as it as it can.
Michael Vorherr:So I've really enjoyed getting to touch base with you, Daniel, and and to learn a little bit more about your podcast.
Daniel Williams:Fantastic. So as we always do, we'll start out with some of your background, learn a bit about Mayfield, get into strategic planning, and then end it with a work life balance question that you and I have already talked about offline and hope our audience will enjoy that as much as I did. So let's do that entry point first. What got you interested in healthcare, healthcare administration? What was that entry point for you?
Michael Vorherr:So I'm not a clinician, and I think I got my start in Lotus one, two, three, which now we more affectionately refer to as spreadsheets or Microsoft Excel depending on on what we're what we're referring to. But I had made an economic decision based on industries, and I had a chance to look in my very early twenties about what industry made the most sense for me to see a long term career in, and the draw into health care for some reason just was overwhelming to me. I ran across a gentleman who was the dean at the time of a master's program who told me that I should get a master's degree in health administration, and so I did. And through that degree, I had an opportunity to do what's known as an administrative internship at a local physician group here in town. And that physician group needed somebody to help them figure out how to pay themselves differently than they were doing it in the past.
Michael Vorherr:My very first job was in physician compensation.
Daniel Williams:Wow. Okay. Let's fast forward a good bit here to where you are now, CEO, Mayfield Brain and Spine. Tell our listeners or MGMA members about Mayfield. Where is it located?
Daniel Williams:Size and scope? Anything else you might wanna share that would be pertinent to MGMA members.
Michael Vorherr:Mayfield Brain and Spine is going to be celebrating its ninetieth year in 2027. It was founded by a neurosurgeon named Frank Mayfield back in 1937, and he was an early pioneer in a lot of innovative neurosurgical techniques and how neurosurgery fit into the the broader market. So we are very pleased and honored to continue his name. A lot of the equipment that folks use in neurosurgery carry doctor Mayfield's last name on it. And he was even involved in the three point seat belt design that we've now come accustomed to in all of the automobiles that we that we design as he and the team at Ford, were contemplating a safer way to get around in the cars.
Michael Vorherr:Mayfield is still entirely an independent practice that is owned by 18 neurosurgeons. So Mayfield is not employed by any health system. It is not part of any equity group. It is just some entrepreneurial physicians who like to take really good care of patients and who like to hold each other accountable. And what I've come to fall in love with about these neurosurgeons is their priority is always how they can make each other better so that the patient has a good experience as possible in such a sensitive area.
Michael Vorherr:So my career took me from independent practice and then for sixteen years inside of health systems. And so inside of health systems, I worked in physician finance, physician practice management, physician recruiting. And so my love of the plight of the physician was something that really made the choice to move to Mayfield in 2021 a very comfortable one for me, one where I felt like I could share not only my passion for physician practice, but also the skills that I have developed both on the hospital side and on the practice side.
Daniel Williams:Yeah. And where is Mayfield located?
Michael Vorherr:We are in Southwest Ohio. Mayfield is currently serving four different health systems, and we provide exclusive neurosurgical services to those four health systems. They cover Northern Kentucky, if the audience is familiar with that region, and then Southwest Ohio.
Daniel Williams:Okay. Now when you you and I talked offline, we were introduced by colleagues of mine at MGMA who had a relationship with you and said, You got to talk to Mark. This guy, he's a talker. He's just got a great way of expressing ideas. One of those ideas is about strategic plans.
Daniel Williams:In learning about you, one of the things I learned is you don't believe in only those really traditional strategic plans, but you believe in something called a living plan. What does that mean? What's a living plan? What's the organic nature of it?
Michael Vorherr:I'm going to qualify this answer by first saying I love hospitals. I don't want anything that I say to sound like it's, I don't like hospitals. We we need them. We love them, and, we work with them. But, you know, I I spent sixteen years working on, what I think most folks refer to as a strategic plan, and we put tons of effort into that strategic plan.
Michael Vorherr:We even three hole punched all the papers in it and put it in a binder with a cover that said strategic plan, and then we tucked it into a drawer. It became really apparent to me about, I would say, five or six years into more of my executive career that those plans made us feel good, but I'm not sure if they ultimately helped us do good. And so I started to think there's... There has to be a way that strategy still carries the importance that people get excited about. They want a strategy.
Michael Vorherr:They want to know where they are going. But at the same time, the strategy should never outweigh the value of what the ultimate objective is of the organization. And so, I did spend some time thinking about, are we organizing our plans in the right way? By putting a strategy first, are we limiting what we can do? Versus if we have multiple objectives, can strategies become something that constantly change?
Michael Vorherr:They live and breathe with the organization. They adapt as change comes in. They go away if they don't work anymore, and a new one comes in to replace it if it does. We live in a environment, Daniel, you you know this as well as anybody, that change is something you can't predict, and it's something that is not gonna go away. And so why not build a model that doesn't refer to a binder but actually changes as change occurs?
Michael Vorherr:And so that's the system that I've developed. I've been using it now for about eight years, and it's not perfect either. But, for my purposes, it really does create a level of accountability and participation that I think are key to making sure your plans reach their potential.
Daniel Williams:Okay. Now something I learned about this strategy process that you have is that you describe strategies as adaptable, even disposable. So my question would be... And that is... It does seem like that's where we're moving.
Daniel Williams:You know? You've gotta be adaptable in this environment that we're in now or you get left behind. But at the same time, you're the CEO of a major organization, so there's a lot of long term planning involved. How do you balance that? How do you balance where, okay, we've got a process, we've got a strategy in place, but we realize we need to course correct.
Daniel Williams:So what what are you studying to know that we're gonna have to kill this project or this way that we're doing things and move it into this direction? Because, boy, oh, boy, that could do great help or it could really send you off in another direction that might be a problem. I've given you a lot to think about, but where are you going? What wheels are turning? What KPIs?
Daniel Williams:What are you looking at to get where you need to get there, Mark?
Michael Vorherr:So I always start with something that's qualitative, not quantitative. So if your objectives... And I use the word objectives where a lot of folks use the word strategy. But if your objectives... And I make it plural because there's always more than one, what are the qualities of those objectives?
Michael Vorherr:So those objectives might have the quality of moving into a new market. Boy, one of the qualities... One of the objectives we would like would be... We would like to move into another market. K?
Michael Vorherr:We didn't define that market. We didn't measure that market. We just said we would like to move into another market. Once we have that qualitative assessment, hey, that's something we would like to do. Then we go through a process of, well, what statistics would tell us if we were successful or not?
Michael Vorherr:I have a rule amongst my team that every objective has to have at least three measures to it. How would you measure that? And so we go through a process every year where we say, okay, here's the qualitative objective that we would like to reach. What are three, at least, measures that tell us we are... Have been there?
Michael Vorherr:Only after the discipline of teams and the wisdom of the group has provided those three measures, do we even begin to use the word strategy? Great. We have three measures. They look beautiful, don't they? Why don't we take those three measures and put at least one strategy underneath each one of them?
Michael Vorherr:And so there's where the strategic part of the plan comes in. It's literally three levels down. It doesn't start with a strategy. It starts with, hey. We said we want to measure these three things that will bring us closer to a qualitative goal that we have.
Michael Vorherr:And then those strategies we know can fall off when they don't work. If somebody has a really good idea and we're six months into a plan, I don't wanna ever look at somebody and say, sorry. We're six months into the plan. Your really good idea is not gonna work. Let's tuck it up under one of those measures.
Michael Vorherr:And so it produces a frequent idea generation principle within the organization. Hey. I've got a great idea. Great. Tell me about it.
Michael Vorherr:It's this. Well, great. Where does that fit in? Well, if we do this, it fits in right here. Perfect.
Michael Vorherr:So now we have an objective that's qualitative in nature, a measure that's quantitative in nature, and then several ways of trying to move that metric in the positive direction.
Daniel Williams:Yeah. You also are a proponent of having updates. And I think the way it was conveyed to me, even when little or no discernible things are happening, you still wanna have those updates just to make sure things are going on, continuing down the right path. What is it about those updates? What is the necessity for them, and why are you a true believer in having those updates, and what's the frequency of them?
Daniel Williams:Give us an idea of that as well.
Michael Vorherr:Before I give you that, I'm going to tell you one of my favorite sayings that a nurse told me not too long ago. She told me, Mark, you like to talk, but I would give you some advice. When you walk into a room, be brief, be bright, and be gone. And I took that very seriously. I said, okay.
Michael Vorherr:That means I have to say what I wanna say as quickly and as efficiently as possible. That's how we talk about updates. So the majority of our updates are monthly. Every now and then, we have a system by which we can correct the administration in there and have them either more or less frequently. If it's typically a qualitative item, an objective, it's quarterly.
Michael Vorherr:If it's something that's more, measure focused, it's monthly so that every kind of financial period would have a report out on those. And then we go through a process where we critique each other's updates. Some people feel it's necessary to put a lot of language into their updates, and they wanna almost retype the plan. Mhmm. We continue to work with those folks until they can be brief, bright, and gone, so that their updates can be as simple as, oh, we didn't do anything.
Michael Vorherr:No update. Or we did this. But the reality is there is no accountability unless you're self accountable. And the art of just making a monthly update, whether it's long or short, creates a discipline and a habit that after a while just becomes second nature here.
Daniel Williams:Yeah. Wow. Be bright, be brief, be gone, at least the three. I like I
Michael Vorherr:have to give credit where credit is due. It was one of our administrative nurses who told me that and it's stuck with me ever since.
Daniel Williams:I hope that nurses trademark that. I could see that on the title of a, self help book. I mean, it's just so, ah, it's spot on. I love that. I've got a couple more questions for you because, I really want to get a deeper understanding here.
Daniel Williams:When we think about health care, we think about it in the context... This is interesting. I will put this into, context of what we're talking about. You talked about your organization coming up on a ninety year celebration anniversary. That's amazing.
Daniel Williams:MGMA just celebrated its one hundredth anniversary and celebration. We... I've mentioned this in the podcast before, but not everybody will have heard this, but we have the notes from the original meeting and a lot of the things that were taken down in that original meeting are still the biggest challenges in healthcare today, getting patients through, getting patient access, getting paid, all of those same issues. There's that side of it, but then on the other side of it, we just see things changing so rapidly, sometimes changing so fast we can't even keep up with what's changing, whether it's reimbursement shifts, technology changes, priorities move. So when you think about your strategy plans, when you think about keeping a plan alive, and the whole world seismically may have shifted.
Daniel Williams:So you may have planned something. Then AI is introduced everywhere, Mark. And all of a sudden you go, well, wait a minute. We're... We still have that objective.
Daniel Williams:We just may do it differently. How do you keep that plan alive when you do see some very different things changing? Or in your physician owned practice, maybe a physician retires, maybe others come in. I mean, things could change within that or technology changes. How do you keep it alive with all these outside forces hitting you?
Michael Vorherr:Tying it back to one of those measures. Because you're right. We are, as health care executives, continuing to face some of the challenges that have perplexed us for decades right now.
Daniel Williams:Right.
Michael Vorherr:And if the objectives of the organization and the metrics are honest to the success of our patient care journey, the success of our fiduciary responsibilities as an organization, they should contain items that these elements that get introduced to us mid year fit under one of these strategies. And you brought up a great one. Artificial intelligence, of course, is a very hot topic and one that we have decided to embrace here. And because of that, we have asked the question... For example, one of our goals is to make sure that we have grown the number of, we call them medical record numbers, unique patients in a particular market.
Michael Vorherr:How does the AI tools of today help us meet one of those metrics, which in turn helps us meet one of our objectives? And so when those new items introduce, the words that my team has gotten very comfortable hearing me say is, oh, that sounds great. What does it tuck up into?
Daniel Williams:Yeah.
Michael Vorherr:Which one of those does it tuck up into? Because we can add it to one of those if it fits one of those models. If it doesn't, then we'll just put it off to the side. So the discipline of planning in my mind is they have to move the company forward towards its objectives. The objectives don't change.
Michael Vorherr:The way to get there will, the way to measure it will, but the objectives should never change. And so when new technologies or new threats, introduce themselves, their plans or mitigations should fit under something that already exists.
Daniel Williams:Okay. I love that. I could talk to you all day about that, but I know that we both have, competing priorities coming up later today. So this is the fun part. We have talked about strategy and we have talked about planning, but you also have a very, I'm trying to think what the right adjectives are, very vivid and expansive work life balance.
Daniel Williams:You've got some things outside of work. These are euphemisms here, Mark. Now I want you to be the one who gets to introduce this. You have got some really cool hobbies and passions outside of your day job. Share with our audience what you shared with me because I think this is so cool.
Michael Vorherr:You will call them cool. My wife might call them obnoxious. Sherry and I, we have five children. They're wonderful. They're adults right now.
Michael Vorherr:And they've all had different hobbies and interests. But one of them that just seemed to latch on to me was my son, Michael, when he was nine, fell in love with magic. And that led me to this journey of looking for magic shops. And I would take him into these magic shops, and he would just be so impressed. But what I didn't realize is that they were going to introduce me to playing cards.
Michael Vorherr:And so while taking him to do all these magic shops, I started to watch these folks do things like cutting a deck of cards with one hand or, learning sleights of hand with a deck of cards, and it led into me needing to know how that works. And I don't do any of the magic tricks with adults because there's a variety of adults that just do not like being fooled. But when I get a chance to work with kids or adolescents who really enjoy wondering why that ace turned into a queen, I will always be willing to do that. It's also led to me learning, what kind of value different cards in the paper that they're... They have printed on create.
Michael Vorherr:And so, unfortunately, my closet, which is important real estate in our house, has about 400 decks of cards in it right now. And I I find rare ones from all over the world, I I collect them, and I like to keep them there. The problem is, and I think you and I were talking about this, Daniel, is I only get invited to one poker game per group of people at a time because I just cannot help myself. I love watching people's expression when they pick up their hand and all of a sudden they have three aces. And they're
Daniel Williams:like Mhmm.
Michael Vorherr:So surprised that that happens when I can very easily organize a deck of cards in my hand.
Daniel Williams:Oh my gosh.
Michael Vorherr:So I don't know if that's cool, but, that's that's what you and I had a chance to talk about.
Daniel Williams:So you you saved this for kids, and I'm a kid at heart. So you you did display some cards a minute ago. Mhmm. Where your camera is aligned, is there anything you can show us for our video, file? Is there anything that's visual that you can share with us briefly here before we sign on?
Michael Vorherr:I can try to do a spring real quick.
Daniel Williams:So if
Michael Vorherr:I drop them all over the place, don't laugh.
Daniel Williams:Judge you.
Michael Vorherr:Okay. Don't judge, but let's see if I can... So there's a deck of cards that I keep. Yep. And I can do a bunch of different kind of cuts with it if I wanted to.
Michael Vorherr:So I think a lot of people know those different types of ways to move cards around. Uh-huh. And then there's something called a spring where after you've learned how to hold a deck of cards, you can Wow. Shuffle it into your hand that way at different heights.
Daniel Williams:That is so cool. That is so cool. Wow, Mark. When you told me that was a fashion of yours, I went, we were already gonna have you on the show, but now that we do a video element as well, and I'm sorry for anybody listening audio only, but please click on the, video version of this just for the last moment to see Mark's, what did you call that move again? What's it called?
Michael Vorherr:That's a spring.
Daniel Williams:The spring.
Michael Vorherr:You got a waterfall.
Daniel Williams:Yeah. A waterfall. It's just beautiful to watch that. Well, Mark Vorher, I am so glad we were introduced to each other, and I wish we had more time. I wanna get you back on the show.
Daniel Williams:We can talk. You also write serial fiction, I believe. Is that correct? And we can go down that pathway as well, talk more strategy. I I just love learning from you and hearing your passions in life, whether it's work related or, knowing your wife and family or getting them involved in all of your passions as well.
Daniel Williams:So thank you so much for joining us today.
Michael Vorherr:Well, and thank you for MGMA and, yourself for all that you do for our medical group associations out there. They're an important part of this country. Your success helps us take great care of patients. And at the end of the day, I think we all are looking for that quality of life. So thank you for all your help too.
Daniel Williams:You got it, Mark. Well, we've been talking to Mark Vorher. Everybody, we are gonna put several links to resources and... To Mark and his organization so you can learn more about that. And, I just wanna thank all of you for being MGMA Podcast listeners.
Daniel Williams:And as always, you can reach out to me directly, dwilliams@mgma.com, if you are an MGMA member and wanna appear on the show. So until then, thank you so much for being an MGMA Podcasts listener.
