Ron Sullivan – Chief Executive Officer,
Medical Review Institute Of America
Ron is the CEO of his firm dedicated to providing clinical insights to payers and patients through analytics and evidence-based clinical opinions. As an active Board member, Ron brings forth a strong analytical approach coupled with diversity in thought and experience that helps companies outperform in their core markets as well as capitalize on inorganic opportunities. In this interview, Ron talks about his experience in medical reviews and his vision for the future.
Starting Out In The Medical Reviews Business
Having spent about 20 years in GE Healthcare, Ron talks about the important role the GE Leadership Program and the mentors played in his career. One of the mentors encouraged him to further his career by joining a private equity-led business named ERT, which is a pharmaceutical clinical trials business.
After a successful exit there and continued encouragement from his mentor, Ron interviewed for and consequently accepted the CEO position at the Medical Review Institute of America (MRIOA).
Three things attracted Ron to MRIOA – firstly, it is a family-oriented business where people take care of each other. Secondly, it is very focused on the patient, by ensuring that all decisions go through the clinical lens of what is best for the patient. Finally, it is owned by a PE firm, Summit Partners, which actually buys and cultivates businesses they believe can help change healthcare and the payer system, and all the things that go with that to drive proper care for patients.
‘There is a lot of rhetoric in the marketplace about the payer market not thinking about the patient and that is really untrue, specifically in this business.’
Current Business Structure And Organization
Even amidst strong competition, MRIOA has grown significantly in the past few years. Ron credits this to a couple of core factors one of which is staying focused on great quality and world class turnaround time, which are hallmarks of MRIOA. Secondly, being dedicated to innovation and creating new products and services that add greater value to their customers.
‘We do 1.2 million reviews a year and 74% of those are turned around in 4 hours or less.’
Talking about efficiency in their operations, Ron mentions that typical medical records received are 50 to 400 pages which are indexed before they get to the MD or pharmacist. At MRIOA, an established approach helps doctors find what to look for no matter how many pages there are. Additionally, there are company tricks and tools along with a fair number of IT software solutions, such as automation, to make the review process smoother.
Talking about their clients, Ron states that they are working with 60% of the top 100 health plans in one way or another. There are seven large PBMs (pharmacy benefit managers), most of which are associated with the company. Additionally, MRIOA has about 900 clinical and case processing resources servicing 900 customers with an average customer tenure of 11 years. There are 700 MDs on the panel as well as a significant pool of internal MDs, pharmacists, and nurses that are part of the clinical staff, located all over the USA.
Standout Moments As A Business Leader In Medical Reviews
Ron mentions that most of his standout moments were driven out of opportunities to learn from other accomplished leaders and mentors. These include working on a project to improve GE Healthcare’s global install base and working with a mentor to break down a complex problem into little pieces and apply risk-based correction strategies to engineer a new platform for Surgical C-arms with millions of lines of software code that would revolutionize the surgical market.
At MRIOA, the company has innovated a telehealth second opinion service called MyCareChoices™ that is revolutionary and ties the second opinion to prior authorization approvals, which has never been done broadly before.
‘Being innovative in an industry that is slow to change as well as having the opportunity to continually learn and be inquisitive has driven success.’
Talking about the company’s achievements and moments of pride, Ron lists the following. First, is the company’s focus on growing amazing leaders, creating opportunities for them to succeed in new and challenging ways. Next, even with the pandemic shifting everything to remote working, the company managed to retain its family culture in a work from home environment.
Innovation is another huge factor at MRIOA. This innovation includes the creation of the MRIOA InsightsTM benchmarking tool set, building out a proprietary Prior Authorization Optimization product that helps health plans provide the best care for patients while reducing unnecessary care, as well as rethinking telehealth second opinion to provide more options for patients at prior authorization time. This innovation coupled with the company’s internal focus on continuous improvement has created what we believe to be a competitive advantage for our clients.
‘With a little help, people have flourished as they have had opportunities to gain new skills by being mentored by strong senior leaders to gain capabilities that serve their teams well.’
The company has also developed a regulatory monitoring system that helps customers stay up to date on the ever changing state and federal regulations and then adapt their Utilization Management process to comply.
Finally, is the core focus of the firm on protecting the interests of the patients. Every decision made ties back to what is best for the patient.
Overcoming Challenges Over The Years
‘Nobody wanted a pandemic, to have people get sick, or any of the aftermaths that came in health care and yet it is still here. But, at the end of the day, it has made us closer, stronger, and more capable as a team.’
The COVID pandemic was a huge challenge for the medical industry and one that Ron says also helped change their business for the better.
To go to 100% work-from-home in about a three-week period forced companies to think differently. For Ron, that was one of the biggest challenges and one in which they have excelled. A second challenge has been innovating in an industry that doesn’t like to change.
Business Plans For Improving The Functionalities Of The Medical Review Business
The team at MRIOA is a big believer in lean process improvement with people continuing to look at clinical case cycle time to identify ways to improve. Additionally, they have a large IT development organization that continues to create new software as well as new application tools for the reviewers and internal case process staff. Along with these innovative practices, there are also new products and services that the firm continues to launch.
Top Philosophies And Core Values In Business
‘We focus on the patient, and it does not matter what part of healthcare you are in, whether in medical reviews, clinical trials, device manufacturing, or direct care, the patient is what matters.’
A core value at the firm is keeping patient care as the primary focus. Ron believes that if the patients are the focus, the company will make the right choices every time.
Another value has been always focusing on being the highest quality review organization in the industry. The patient deserves to know that they are getting an expert opinion from a medical doctor, a pharmacist, or a nurse; so, the firm looks at quality as not only a hallmark but as an important requirement along with a fast turnaround time. Ron states that there is no reason for a patient to wait for a medical review and postpone care.
Advice For Newcomers Looking To Start A Career In The Medical Review Business
At MRIOA or any other healthcare business for that matter, start off by being humble, inquisitive, ask questions, show others gratitude, help others grow, and always focus on what is best for the patient.
Emerging Trends Expected In The Medical Review Space
First, there are many state and federal regulation changes being launched and others in the works that will require many customers to make changes. Secondly, there are a fair number of very expensive drugs being launched in the market and while they are interesting, Ron believes the industry is going to have to figure out how to deal with their emergence to ensure the best care for the patient.
For companies and professionals hoping to remain successful in this domain, Ron advises going back to the basics of humility and active learning. Another is to be open and honest with no hidden agendas in communications and have a strong focus on the purpose for the organization so everyone knows why they are getting up in the morning and coming to work.
‘If everyone will take the extra steps to help others around them succeed and focus more on that than themselves, those efforts will come back to serve everyone well.’