Family physician-turned-high-tech-entrepreneur Dan Mingle oversees 50 employees at Mingle Analytics, headquartered in South Paris. Staff telecommute from 11 states. He didn’t expect to be able to grow the business while staying in Oxford Hills, but it’s working.

1. What do medical practices hire Mingle Analytics to do?

Medicare is trying to broker a change in the way the nation pays for health care. Our payment system has traditionally been a volume-based fee-for-service system that has led to skyrocketing health care costs and to a health care system that is the most expensive in the world. Medicare, to get to the point where they can pay for value rather than volume, has introduced a number of penalties and incentives to convince doctors to provide data about quality-of-care so that higher value care generates better payment.

Practices from all over the United States, of all sizes, types and specialties engage us to help them successfully deliver quality of care data to Medicare. Medicare’s requirements are complex, often contradictory and change rapidly. We help our clients first to understand the Medicare requirements and options. We are the best there is at finding a way for every interested practice to find a way to successfully submit.

2. How has your own background as a doctor helped in becoming a high-tech entrepreneur?

Most health care technology companies are led by technology experts who have no experience in health care. In contrast, I have deep and intimate experience in health care combined with enough technical and business knowledge and experience to be effective. I have owned and operated a private practice in rural Maine. I’ve been a physician leader and executive. I’ve been an educator of new doctors and I’ve earned a second advanced degree from Dartmouth dealing with the measurement and improvement of health care. I understand the pain that these new Medicare programs are causing in practices. And I understand how to create effective solutions for them. That knowledge and understanding has proven itself in the marketplace and led to our explosive growth in the national market.

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3. The challenges and advantages of having a workforce spread across the country?

I am an older entrepreneur and was raised in a world without cellphones, internet and social media. I learned the usual business-bias against remote work or telecommuting.

When I started this business, I expected the growth we have enjoyed: in four years we have grown to 50 employees serving 1,700 clients representing 32,000 providers in 50 states. But I did not expect to support a remote workforce. I expected that my staff would come to the office every day. Though I established my first office in Oxford Hills where I have lived for the last 36 years, I expected that as the business grew I would have to move south to access bigger labor markets. I would likely maintain a small headquarters and home office in Oxford Hills, but I would have a second office in Portland, then a third in Portsmouth or Boston, and perhaps eventually offices scattered nationwide.

We experienced two surprises: First, we found that remote connectivity tools are far better than they were even five years ago. We can connect large or small groups together with high-quality audio and video links from multiple sites at a moment’s notice.

Second, against conventional wisdom, we have found that most people can work very productively and manage their time well at home. Working from home is not for everyone. Some people find it too distracting and need the office to stay on task. But for most, we’ve given the daily commute time back to them as productive time. And people lose less work time to attend the inevitable personal tasks that require them to be home or out in the community. In fact, with more freedom to choose when to work out of any 24-hour day, we find people far more productive and having far more fun in the hours that they choose to work.

If we had any doubt, those doubts were dispelled in the winter of 2015 when a series of snowstorms kept us out of the office for most of two weeks. Winter happens to be our busy season. Business never stopped or even missed a beat on snow days. Clients’ needs were met. Development continued full-bore. The only difference was that we worked and met together in pajamas from home instead of work attire at the office. (“Pajamas” might be a bit of poetic license.)

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The challenges of the dispersed workforce include: We are subject to the labor laws and state taxes of every state where we have an employee. There continues to be value to the in-person face-to-face meeting and that is difficult to engineer in a dispersed environment. It is harder to accommodate the needs of an employee who needs an office or face time to work effectively.

The advantage of the dispersed workforce is that we can engage any person at any time and they don’t have to relocate to do it. It means that we can choose from a much bigger potential workforce. You don’t have to already live here or be willing to relocate here to be eligible to work here. A potential recruit can “try us risk-free.” You don’t have to have the certainty of fit and future that you would need to disrupt home and family and community ties to relocate to a distant unfamiliar corner of the country. As a result, we have our pick of the most talented resources available in the nation and a faster recruitment and on-boarding process than we would otherwise enjoy.

For the few folks who need an office, we have been experimenting with co-working space. Co-working space gives us an office presence in any city in the nation for a fraction of the cost of maintaining a full office.

4. What is a policy or issue you’re following this spring at either the state or national level, and what impact could it have on your business?

Rules and requirements for health care quality reporting are changing rapidly. The most recent change is the Medicare Access and CHIP Reauthorization Act signed into federal law in April of 2015. It had bipartisan support and dramatically changes the programs with which we work. Programs combine, names change, penalties increase. In the long run, it is great for business. Health care practices need us more than ever to understand and comply with the rules and to avoid serious penalties.

In the short run, the legislation only sets a vague outline of the new programs and has created confusion in the market. Medicare is making rules that will put the new law into operation. The “proposed rule” will be published within the next few weeks and will trigger a time-limited invitation for stakeholders to comment on the proposal, which will be followed by limited time in which Medicare will have to process the input and create a “final rule.”

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As they say, “The devil is in the details.” We will need to bake the “final rule” into all of our algorithms and processes in the short period of time between when they are published late in this calendar year and when they go into effect the first of January 2017.

5. Congratulations on the recent $34,000 Maine Technology Institute business accelerator grant! How will that help your company?

Maine Technology Institute has been good to us and for us. Their mission is to provide development support for promising technology companies that can provide jobs and build Maine’s economy. This particular grant is an add-on to a development loan they provided a year ago to help us build some of the software we use to meet our clients’ needs. This grant is intended to be used for marketing to get that new software more quickly to the attention of our potential clients and generating more business and revenue. More business and more revenue equals more jobs here in Maine and a boost to the Maine economy.

6. If you received a $1 million grant tomorrow, no strings attached, what would you invest it in?

I would invest a third of it in a disciplined marketing and sales program. Our phenomenal growth to date has been predominantly on word-of-mouth marketing. Satisfied clients tell their friends about us. And with such meager investment in marketing, we’ve been growing as fast as we can manage. We are interested in seeing just how fast we can grow if we put some disciplined marketing and sales efforts in place. Other companies have to market and sell. We figure it’s time for us to pay our dues and be like everyone else.

Our growth to date, driven almost entirely by word-of-mouth, has been hard to keep up with and informs us of what else we need to invest in. Another third of the funds would be used to beef up our network connections and the capacity of our database and data systems. We serve about 32,000 doctors and other health care providers today. There are nearly 900,000 who will need a vendor, like us, within the next few years. If our marketing is effective in letting potential clients know just how good we are at what we do, we will need technical capability to deal with the data of hundreds of thousands of providers rather than mere tens of thousands.

The final third of the $1 million dollar grant would hire and train more staff to be prepared to efficiently and effectively guide hundreds of thousands of new providers through the decisions and processes to accurately complete their annual quality reporting.

Six Questions for the CEO is a monthly feature on the faces and names that keep business interesting. Contact staff writer Kathryn Skelton at [email protected]


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