When Kyle Duke joined PatientFocus, the company was feeling the kind of pain every company wants to feel. It was growing.

Fifteen years ago, the market wasn’t ready for PatientFocus. At that time, healthcare costs were primarily covered by insurance. Only 10 percent (or less) of a provider’s revenue came from individual patients. Of that 10 percent, only 10 percent was fully collected, but in the grand scheme of write offs, that wasn’t worth the cost of investing in a solution.

Things started changing in 2008. Today, individuals account for 30 percent of a provider’s revenue, but the collection rate has remained at 10 percent. Do the math, and you’ll see what PatientFocus founder David Frederiksen saw. That’s a hit to the bottom line for the big players. It would be devastating for the smaller ones.

PatientFocus serves hospitals and other healthcare providers by managing collections from self-paying patients. But they don’t do it in the same way it’s been done before. The company works on behalf of the providers, but focuses on patient experience. The system makes it easy for patients to ask questions, get clarity, and set up payment plans when necessary. Often patients don’t even realize they’re working with a third party.

Things were going well for PatientFocus. So much so that in 2015, the company realized a huge bump in sales. And then the technology-related problems started.

“In 2015, the dam broke,” Duke says. “We sold 15 new clients, and nobody could keep up. We couldn’t get them on the platform, it took too long to onboard them…so what we saw was this huge growth in revenue and huge growth in expenses because we were having to add as many people as we were clients.”

When Duke joined the company, he was tasked with finding a solution. His approach could be a master class in adapting technology to solve business problems.

Step One: You Are Here.

Before making a single technology decision, Duke and Frederiksen spent three or four months digging into the core of the business. They hired an outside consultant who guided the process, uncovering data and trends with the cold eye of a third party. With potential revenue being lost every day, and dozens of clients and employees to consider, throwing things at the wall to see what stuck was no longer a good option. They needed strategy a strategy to handle the Iron Triangle.

iron triangle


The timeline for building a new custom platform did not line up with the company’s customer and internal demands. Moreover, with the developer team already working nonstop just to handle maintenance, going back to square one would take substantial investment in technology staff. With serious timeline and budget implications at play, it was clear: rebuilding from scratch would not work for PatientFocus.

Instead, Duke and the team looked broadly at everything they needed their system to do in order to find alternative solutions. They looked at process, workflow, documentation, technology, and where the system was breaking down. The goal was to automate the process, making it repeatable and scalable, while also serving individual clients.

It became obvious that a third party solution–with heavy modifications to serve the PatientFocus purpose–would solve their problems faster, cheaper, and provide better service to their employees.

Step Two: X Marks The Spot.

After settling on a solution, it was time to start building. Which meant a hard conversation with the company’s developers.

“Ok, we are not going to rebuild the platform from the ground up,” Duke remembers telling them. “That was day one. By about day 10, all 8 of them {the developers} were gone.”

It may have been a painful time, but that firm stake in the ground served both PatientFocus and their employees. The developers were able to identify that it was time to find jobs that would meet their career goals more fully, and the company was able to funnel expenses to the right resources.

It’s important to realize, though, that the PatientFocus team could not have outlined this same map when the company was founded. They needed to dive in and build their first MVP in order to understand client needs, their own workflows, and what processes are most easily automated. They drew a solid map from their current location, but, like most successful companies, they had to do some learning and course-correcting in order to reach that spot.

Step Three: Take The Team With You.

Sometimes. As we’ve seen, when there are shifts in technology or strategy, there will be some people who will find new opportunities. But for the team members who stay, technology change is people change.

Frederiksen and Duke managed this change by extending their relationship with their consultant. They understood that even though the team was onboard, change is hard. Even good change.

Every week during the transition, leadership mapped where every single employee sat on the change curve. They made a plan for helping the ones who struggled or fell behind. With timeline as a driver (the rebuild was slowing sales), the company could not afford delays. Duke credits that level of employee shepherding with their success.

“For us being able to start building in December and put the first client on in August, that’s the only way that happened,” he says.

Lessons Learned

Decisions like platform and custom vs. third party seem like technology decisions. But these are really business decisions. With the right strategy, technology can affect every part of the income statement – it can increase revenue, reduce variable costs, and reduce overhead (or keep it constant in the face of growth), all of which results in a healthier bottom line.

For PatientFocus, changing their technology more than doubled their daily activity. On the old system, they completed about 500 outbound calls to patients a day. Today, they can manage up to 1200. Employees are now able to focus on high value work (talking to patients) instead of menial tasks like looking up phone numbers and records. That means more revenue, for them and their clients, while also keeping headcount and overhead low.

At a high level, leadership is no longer worried that the system may crash at any moment. Being secure in the knowledge that the core technology would run smoothly equals exponential return on the CEO’s brain space. Now, rather than praying the technology works again today, he – and the sales team – can focus on growing the business.

The PatientFocus story reminds us that business and technology are no longer separate. Finding the right technology is worth the effort because it can literally make or break your business.

It’s 2017. MOST businesses today use software in some way or another. We’ve talked aboutcustom and off-the-shelf software before, but regardless of what your business model is, you probably need at least some off-the-shelf software to run it.

Small businesses need to answer a new question: not “Should we incorporate tech into our practices?” But, “WHICH tech is most valuable for us?”

Thoughts on Business Software Tools

Okay, so if you need off-the-shelf software, how do you know what to pick? Each industry has its own unique tools, but a quick survey of our team yielded some great advice for any business owner.

Bootstrap first. What can you do to duct tape a solution together? If you spend some time solving a problem without software, it will give you a better understanding of what you need and why you need it. Example? We’re currently working on a solution to our complex scheduling challenges. With several developers and projects going at once, keeping up with the schedule gets complicated. Post-it notes and a whiteboard will help us see the whole problem. Then, if that low-fi solution doesn’t solve it, we know where to start building.

Pick the right size. One of the worst things you can do is overbuy. You don’t want software to be so high touch it hinders your team rather than helps them. You also don’t want to buy a whole suite of software for one feature. If you’re going to make the investment, take the time to train and implement the solution fully. You also want to make sure the cost doesn’t outweigh the benefit. Huge licensing fees or custom building costs aren’t always necessary.

Stay close to the money. We say this all the time around the office. Don’t ever let the allure of software distract you from your core business. If software costs (in either time or money) pull you away from building your customer base, shut it down!

Business Software We Use And (Mostly) Love

So, what software does a company full of developers recommend? We do use some software specific to developers, but we also use some tools that we think would benefit any business.

  1. Slack. Hands down. Everyone on our team loves and recommends this chat tool. Even when you run a small team, the accessibility is invaluable. You can talk to the team easily, but you can also share and store documents and other files for easy access. Our tip? Set a company policy for when people will be available and when everyone will be on “do not disturb.”
  2. GSuite. At this point, most of the world runs on Google. But, if you’re still not on board, Google Apps was the second most recommended software in our team survey. Gmail, Drive, and Calendar all work together to keep your team on track. Company-wide buy-in is important, though. For example, at Centresource, most of us keep our calendars up to date so it’s easy to schedule meetings without 50 emails (or Slack messages) nailing down a time.
  3. Project Management. We use Trello, but everyone has a favorite. (And our developers have opinions…) Basecamp and Asana also have their merits. Even if you don’t identify as a project-based company, you probably have projects more than one person contributes to. They could be internal or external, but regardless it’s vital to put all of the information in one place. I use a Trello board for this blog’s editorial calendar. It makes it easy for me to remember, but it also gives my teammates access to what I’m working on and opportunities for them to contribute.
  4. CRM. Regardless of size, customer relationship management (CRM) software organizes contacts and streamlines interactions with them. There are a million options out there. We like Contactually for email flows and Pipedrive for sales pipeline data. The Hubspot CRM is also a great tool that can easily integrate with other marketing efforts.

What tools are you using to build and grow your business?

Holacracy is yet another buzzword in technology. The idea is that the people best equipped to make decisions about work are the ones doing the work–not managers. Holacracy gives that power to the right people, within a pretty rigid structure of meetings and processes.

There’s a lot of controversy around it, of course. When Zappos’ CEO offered severance for employees not on board with the system, 6% of the company took it because of holacracy. Like every other type of work, it’s not right for everyone or every company.

We weren’t quite sure what to expect when we transitioned a year ago. Holacracy has a steep learning curve, and learning to make decisions together took effort. And, you know, we have a business to run.

But, a year later, it’s safe to say the move was the right one. And not just for us. For our clients as well.

Holacracy Improves Software Development

Zappos adopted holacracy a few years ago, so many people associate it with Tony Hsieh. In reality, a developer created holacracy. Brian Robertson conquered software development early in life, but he felt stunted by management decisions and bureaucracy. Self-management for himself and his employees was the goal when he started his own development firm.

During that time, though, Robertson learned that culture can’t solve all business challenges, and many flat structures didn’t have the processes in place to run efficiently. Over the years, he developed holacracy to meet those needs.

Because the system was developed at a software company, it is uniquely designed for the work we do at Centresource. Holacracy works well with agile development, which we use in a modified way to tackle complicated projects.

In general, the decisions you make are only as good as the information you have. Holacracy empowers our team (and our clients) to see all of the information, instead of only what a manager deems necessary. This allows our developers and clients to make better decisions and build software more efficiently.

Holacracy Improves Client Experience

One criticism of holacracy is that it is self-focused–inward, instead of customer-centric. It’s true that we spend a lot of time thinking about how our business runs, and that was especially true during the learning phase.

But, we’ve also realized that holacracy has made us all better business owners and consultants.

Everyone at Centresource is personally invested in and responsible for their work and client success. Over time, we’ve developed better intuition about what could help our clients. Developers don’t think in a silo of code. They also think about the best solutions for the business problems facing clients.

We build software. But, we actually strive to be a business partner with our clients. What’s the difference? We use technology to solve business problems like driving revenue, conversion, and operational efficiency. In the last year, we’ve discovered that holacracy empowers our team to more efficiently serve our customers in these efforts.

Holacracy As A Tool–Not A Golden Ticket

Some people see holacracy as a “no authority” model, but that’s simply not true. Rather, holacracy is “distributed authority.” Everyone is charged with responsibility for meeting client needs. More importantly, they’re empowered to do so without red tape.

We see holacracy as an operating system. What started as a quest for individual autonomy has actually become the most valuable way we can serve our clients. If it ever stops being valuable for the partners we work with, we have the authority to change the system.