Jerry Vicenzi, President & CEO, Synernet, Inc.

The following is a transcript of our interview with Jerry Vicenzi. To find links to the audio files and more information about the interview, please click here.

These transcripts are made possible by a gift from the NNEAHE.

Bonica:

        Welcome to the Forge, Jerry.

Vicenzi:

        Glad to be here.

Bonica:

        You earned both your bachelor's and master's degrees from Rensselaer Poly Tech Institute in mangement engineering. Why did you go to RPI and why did you choose management engineering? What is that as a field?

Vicenzi:

        Well, I grew up in the ... I was a baby boomer and the son of immigrants who had elementary school education, but understood the value of education and always preached the need for their children to get a college education, and so it wasn't really ever an option in my mind, even though my father was a skilled laborer and had a real good skilled trade that I could have learn. He was always ...

Bonica:

        "You got to go to college."

Vicenzi:

        "You got to go to college. You have to go to college."

Bonica:

        But why RPI and why here?

Vicenzi:

        RPI because interestingly, you know, things don't always work like the way you want them to work so in those days, we applied to three schools: your top school, your middle school, and your safe school. I didn't get into my top school, which was Brown University.

Bonica:

        Well, yeah. Most people don't.

Vicenzi:

        I wanted to go away and my safe school was Northeastern, that was Boston, so it was RPI.

Bonica:

        RPI's a very good school. Let's not be [crosstalk 00:01:23] now.

Vicenzi:

        RPI's an excellent school and actually I think it's profile has risen substantively in the past, since we left. I don't know if I'd be accepted there now. Yeah, and I thought I wanted to be an engineer. I don't know, I had fairly good math and science grades, my liberal, you know, my English was never like ... I was never an A student in English and in writing and creative writing and all that. I actually write very well from a business side, that was everything. I just got to get the skills.

        I just thought that engineering was a good fit for me. When I got there, I found that some of the technical stuff was a little too technical for me. Management, industrial engineering afforded the ability to work with people and process. I'm an organized person, and I just thought it was a real good fit.

Bonica:

        It's not something you knew about before you got there, but you learned about it when you got there?

Vicenzi:

        I didn't know about it at all. I thought I was going to be an engineer of some sort.

Bonica:

        Okay, and you stayed and got your Master's degree, or did you do that later?

Vicenzi:

        No, I did, I stayed and got my master's degree because when I was a senior, RPI received a grant from the Kellogg Foundation to train industrial engineers to work in hospitals. It was kind of an easy decision. It was like, "You want to grad school?" When you look at your career prior to that question, it's like, "I've been going to school all my life. Why should I go to school again?"

Bonica:

        Yeah, so industrial engineering kind of was something you discovered once you got to RPI. What about healthcare? Specifically, this master's was, specifically, healthcare. Had you had thoughts that, "Hey, I'd like to [crosstalk 00:03:06]?

Vicenzi:

        Well, no actually, interestingly-

Bonica:

        It was just kind of an opportunity.

Vicenzi:

        While I was a senior, I'd started working part-time at the New York Hospital Association in Albany and they had a consulting group that did a broad range of things for hospitals around the state, and so, I was a technician, as they called them in those days. Basically, did spreadsheets before the spreadsheets. Edited data cards before you could do stuff online. I was a technician and I got engaged with healthcare there. Just happened that-

Bonica:

        Then the Master's was offered?

Vicenzi:

        RPI offered the master's in healthcare, and my career path was chosen.

Bonica:

        Wow, how neat.

Vicenzi:

        Or divined, I guess, I didn't choose it. I'd like to think [inaudible 00:03:56] like that I get a little more conscious, I guess, I don't know. I'd like to think that I would have been a little more conscious about the decision, but I wasn't. I mean, reality, it occurred. Sometimes, things like that happen in life, as you learn later in life. Sometimes doors open. You know, one closes, another one opens, and you move through the door. I had another situation later that I'll talk about that occurred.

        Yeah, so when I left there, my first job was actually working for a hospital association in Rhode Island as a management engineer. It's interesting, my first job was in a shared services organization that was part of the Hospital Association of Rhode Island.

Bonica:

        Interesting.

Vicenzi:

        Hospital Association does, typically, advocacy and public policy work, and in many states, they have service arms, they have a service arm, and they just happened to have a service arm. You know, at the time included, one of the first industrial engineering programs to be shared by hospitals in New England.

Bonica:

        Okay, so you're kind of a consultant, then?

Vicenzi:

        Yes, I was a consultant, I was a staff consultant and we worked around the State of Rhode Island at different hospitals doing process improvement and productivity improvement work before it was popular.

Bonica:

        Oh, neat. Wow.

Vicenzi:

        I think that was ... Probably the best part of that job, was that I really finally began to understand that I had something to contribute. When I went out of school, I felt like "I got all this education, but I don't know how I'm really going to apply it to the real world." How does it really work? My first job just gave me good footing. I mean, I was fortunate. I actually worked for one hospital, Newport, Rhode Island, I did a lot of work, so that was a really nice ... Leave Providence, take a nice drive to Newport. That's just pretty nice, but there was a gentleman there named Bob Heeley who was the COO, and what I find in life is that sometimes people see more in you than you see in yourself. Bob Heeley saw a lot of me.

Bonica:

        Oh, nice.

Vicenzi:

        I did a lot of work for Bob directly, you know, his projects, he needed done, he required either process work, you know, I had to work with the director of the labs at the time who was an ornery pathologist, but he needed help buying a new analyzer. Bob said "Hey, you know, I need an economic comparison of what he's buying, you know? And what the advantages are and the disadvantages." Bob treated me like, I'll tell you, at that time, as a 24 year-old, Bob treated me as an equal, my opinion mattered. I mean, it was great.

Bonica:

        He's kind of a mentor to you?

Vicenzi:

        He is kind of a mentor in those days, when I look back on it. It really made me feel ... Actually he and the other individual as the CFO that was named Edward Camps were just wonderful to work for. Especially when you, like I said, you're fresh out of school, you really don't know how ... You have to say "Is it really going to be accepted? Does it really mean anything?" It was a great experience, and I left there because I really thought I wanted a more high-profile consultative role. I mean, I get involved ... Actually, at the time, I actually got involved in the hospital management system society, which, today is HIMSS, and is a little bigger, at the time it was hospital management. I mean, that started my involvement with professional organizations way back then. Found that networking opportunity that you get from being with other professionals in your discipline really valuable.

        As a result, I was close to larger consulting organizations like Princeton Young or it was Ernst and Ernst at the time, I think it's Ernst and Winnie now. You know, Arthur Anderson. About three years into my job, I really decided I really needed to look for something a little more high-profile. I interviewed with Chicago with two companies, Ernst and Ernst, at the time, and a company called Medicus Systems Corporation, and in '76, I took a job with Medicus Systems in Chicago at Rush Presbyterian Saint Luke's Hospital. They had an on-site program there to provide engineering services. They also outsourced the data processing facilities, and they just outsourced, so Medicus' concept in those days was that business process and industrial engineering and computer systems should be one. Try to meld the three systems in a company, and we were very successful. Had some really substantive, you know, some well-regarded clients at the time. Rush Presbyterian Saint Luke's became my home base with Medicus and I spent about two years, did a variety of different projects for Rush.

        Then, your career progresses, and people, someone sits you down and says "You know, we've got our next opportunity for you." I'm going "Wow, this is wonderful." You know, I've only been here for two years, I've already got another opportunity, [inaudible 00:09:07] good work. I mean, I'm being rewarded and I said "I'm all primed." They've got hospitals in Texas, Florida, California, I'm going "We want you to move to Cleveland, Ohio."

Bonica:

        That was probably at the top of your list.

Vicenzi:

        Just a little bit of a setback.

Bonica:

        Okay.

Vicenzi:

        In fact, I remember, I was in Biloxi, Mississippi at the annual HMSS meeting in February, and talking to people and they're going "You're going where? You're going to Cleveland?" It was sort of of '78, and some other east coast, the Midwest, it was one of those years, and so in '78, I moved to Cleveland, Ohio, and doing the same work with Medicus for Mount Sinai Medical Center. I was the manager for the program at Mount Sinai Medical Center. I got a promotion and I transferred to Cleveland, Ohio, and their beginning, let me think, thinking back about a 13-year relationship with Mount Sinai Medical Center. First as a consultant, then as an employee, in two different stints of employment.

Bonica:

        Oh, okay, all right.

Vicenzi:

        Eventually, you were the vice president of support services for Mount Sinai.

Bonica:

        Right.

Vicenzi:

        That was my last round at Mount Sinai.

Bonica:

        You'd been there, you left and come back?

Vicenzi:

        Yeah, I'd been there, I guess I'm still struggling to find an identity in my twenties. I was getting tired of the consultative role, but I felt consulting, you give advice, and then people don't do what you tell them to do. You become credenza wear, a nice report on a shelf and although, I have to say, there was a gentleman at Mount Sinai Medical Center who is similar to Bob Heeley, was a COO there, Warren Greenwalt, who really appreciated the work I did. I mean, I was just ... We just got along fabulously, and that eventually came back to pay dividends for me. About three years into that stint, I got one of these wanderlust things that I was just going to go out west and go skiing for a year, and the folks who ran the company said "Hey, you know, I got a great situation for you in Saudi Arabia." I said "Saudi Arabia?"

        The company I worked for, Medicus, had sold their consultative interests, and to a large conglomerate who just managed, operated hospitals for the ministry defense and aviation in Saudi Arabia. They had loaned talent to the active vision over the course of the two years and they say "Hey, you got an assignment over there for four months. Why don't you do that, when you come back, you can figure out whether you want to go do something else."

Bonica:

        Okay, so knew that you were kind of burning out, maybe a little bit, and just gave you something different?

Vicenzi:

        Yeah, gave me something different to do. I still had a really fascinating experience just traveling in the Middle East. Even in those days, it was a little scary. You know, now, it's totally different, it's not western culture. Yeah, I spent four months there and the nice part about that is after four ... It wasn't even four, it was more like three and a half, I got an extra four weeks of vacation, in addition to that. That was my deal. My deal was four weeks vacation, extra week's vacation, so I traveled, went to Egypt for about a week and a half, and did all the pyramids and down to the Luxor and came back and went to the Greek Islands, and worked my way back from Greece up through Italy, over to France, and when I got to Paris, I actually had met my other and my sister there, because we actually have relatives in France. By the time I get to Paris, I was about six or seven weeks in from my travels.

        You know, my goal was it was time to go home. I went on a plane in Paris to go back to the United States, and then spent about two or three months getting on a plane ever week out of Boston working for Medicus, back doing consulting work. That was never ... I mean, being a road warrior was never my thing in life, and I got a call from Mount Sinai, and they said "Well, why don't you come back here and work for us? We have an opportunity for you to come back and work for us." I went back, moved back to Cleveland, Ohio, and went to work with Mount Sinai Medical Center.

Bonica:

        You were there for quite a while, as you said?

Vicenzi:

        It was probably nine years, interrupted by a brief, one-year stint in the headhunting and recruiting business.

Bonica:

        Oh, is that your work as leadership strategies?

Vicenzi:

        No.

Bonica:

        Okay, that was something else?

Vicenzi:

        That was after the fact. It's amazing, things change in organizations, leaders change, some things stay constant, but I had left for a year. I don't remember the whole situation, why I had left. I had actually decided "You know, I wanted to try to do something where I was a little more vested in the enterprise." I had met this individual who was a real professional. He'd been in the banking industry, and he had basically bought a recruitment practice for accountants from a national. He was the principal, and he was looking for additional people to work with him. Particularly on the technology side, because I had ... While I wasn't programmer or IT person, my experience was I had been working in my organization and working with him, and he was someone who wanted [inaudible 00:14:46] decks, those kinds of things.

        I went to work for him for a year, and that was a real post-graduate education, in my mind, because it taught me about making a call in sales.

Bonica:

        Okay, yeah.

Vicenzi:

        Which is something they don't teach you in college.

Bonica:

        Could you even learn that in a classroom, do you think?

Vicenzi:

        I don't think you learn that in class. Really, I mean, that's a school of hard knocks.

Bonica:

        Right.

Vicenzi:

        You know, because it's like "Here is a directory of people to call. Here is the phone, go make your calls. Introduce yourself. You know, get to know people." You know, it was real difficult to start, and by the end of the first year, I was beginning to gain traction, and then I got a call from Mount Sinai again. My friend Warren again, he goes "Things have changed again here, we need you to come back again. We're going to make you a vice president."

Bonica:

        Wow.

Vicenzi:

        Give you, I mean ... I was in this business, it was a commission business. The first year was not very lucrative, so at that point, actually, I got married the same year.

Bonica:

        A little stability was appealing at that point.

Vicenzi:

        The stability was appealing, and I guess that wanderlust thing of took me to Saudi Arabia, took me from Rhode Island to Chicago. It's like I think it's the stability. I had the [inaudible 00:16:12] a lot, but, yeah, so, I went back and I served there for five or six years as vice president support services.

Bonica:

        What was that role?

Vicenzi:

        That role was basically coordinating the functions, the administrative support functions of the organization; environmental services, food services, supply chain, security. Non-clinical-oriented functions within the organization. Safety, that's a difficult one to be in charge of. Safety and security, those are very difficult things to be responsible for. I was on the administrative response board, and what I really learned there was the value of teamwork and having a team. I had great people working for me and part of that was the fac that I recruited at least three or four of them, and I realized how important it was, just if you are in an executive role, and you have broad responsibilities to have really, really strong leaders working for you.

        That taught me that very, very clearly, and distinctly. I spent my five or six years, there, and then I got caught in a downsizing.

Bonica:

        The hospital was downsizing?

Vicenzi:

        The hospital was downsized.

Bonica:

        Yeah.

Vicenzi:

        This was kind of like the late eighties, this was like the early nineties.

Bonica:

        The early nineties, so you're seeing the effects of PPS, probably?

Vicenzi:

        Yeah, right, yeah. Prospective payment system had begun and it was somewhat a bit of a ... What's the word? I would call it a slap in the face. More like "How could this possibly happen?" I mean, you know-

Bonica:

        Really caught you by-

Vicenzi:

        Two months ago, "You know, you're doing such a great job, Jerry. We really appreciate it." You know what I mean? Then two months later it's like "Sorry, we're cutting out your position." Organizational politics, dynamics or whatever it was. I mean, I got caught up, it was probably about 20 or 30 other key people. It wasn't just a small ... What had happened in that 12-year timeframe, or that timeframe at Mount Sinai is I really focused on the job internally, and kind of let any kind of network, exterior to the organization drop.

        I wasn't relating a lot with people external to my job.

Bonica:

        You had made that a point earlier in your career, though.

Vicenzi:

        I had made it a point earlier in my career, and then I-

Bonica:

        Then you got let go.

Vicenzi:

        Realized the positives and importance of that. I was in this situation, and I was subsequently ... In those days, just scary, or 25 years ago, or more than 20 years ago, organizations were pretty generous with their severance packages. So we had a really decent severance package. Besides that, we had full outplacement services. Outplacement services, we had an office to go to every day. You can get up every morning, get dressed, go to an office. Have access to expensive kind of service, they don't outplacement anymore, very ...

Bonica:

        Right.

Vicenzi:

        That was a reawakening experience for me in terms of the need to really just build a network of people. You know, and to be out there and in that timeframe where I couldn't find another opportunity or another role, I started that consulting practice to do work, which kind of leveraged off my, what I basically knew, that was my focus was like "What can I leverage off of this?" You know I know a little about leadership, I've managed a unit of an organization and I understand the importance of being a leader, and of having sound people working for you and good managers, and relying on them.

        I understood systems and productivity and processes, and so I tried to combine something into a practice to do work, and it was tough. It's a tough goal being an independent consultant.

Bonica:

        Yeah, well, you've got to build that practice.

Vicenzi:

        Yeah, you've got to build a practice, you've got to build a presence.

Bonica:

        Build your network again.

Vicenzi:

        Huh?

Bonica:

        Build your network.

Vicenzi:

        Yeah, build your network, and, I don't know, I put together a nice, I still may have it somewhere, a very nice brochure, kind of describing what we do, who we are, and I'm sort of proud of that. I got to get out there and secure a few engagement. I had secured a few engagements, small ones, not that they were really large. In the middle of this process, I get a phone call from a headhunter. It just dates back, "We got your name from Mount Sinai Medical Center a year ago, would you be interested in talking to us about this opportunity at the Greater Cleveland Hospital Association."

        I'm looking at my ... I said to myself, I remember, I said to the headhunter, he goes "Are you interested in talking?" I go "Well, you know, I got to look at my schedule. Like, consulting my people." Yeah, right? "Yeah, when can we get together?" One thing led to another, and once again, I opted for stability, interestingly, my son was born that same year, so I had a one-year-old, in '92, or by the fall of '92, I had a one-year-old. My wife and I had moved from our home, which I had bought. We bought this really nice home on a golf course, and it's a very nice home, and I mean, when I lost my job at Sinai, after about nine months, it was like "We got to do something, we really can't." We rented the house out for two years, so we were living in a condo, you know?

        We were paying rent, but we were renting a house and our condo, and I was making a little, but the job at the association was kind of a safe harbor, in a way. I looked at it that, it's a safe harbor, Jerry, you should take it. Just go there and take it. What was I doing for them? I was their vice president for materials management services. Again, back to my roots, another association, advocacy, public policy, public health initiatives in the greater Cleveland Area, where the big services are, a lot of big services are, and one of the big services was buying group purchasing, and despite the fact that I had not had a hands-on experience with the purchasing function of the supply chain, and it reported to me at Mount Sinai Medical Center, and I understood it, and I knew it, and the CEO of the association chose me for this job over a couple of people who actually were directors of materials management at local institutions. I got to know those guys pretty well over the course of the next seven years, because they became my customers.

        Again, in that case, Wayne Rice, someone's seeing in you what you don't necessarily see in yourself. I mean, you have value to offer, to that. Sometimes it's not intrinsically apparent to you, as you know, your career develops. Some people have this overwhelming self-confidence. Not everybody does. I could say I didn't. Wayne saw something in me, I went to work there, and in seven years, we grew that group purchasing program to a quarter of a billion dollars in gross purchases from like 70 or 80 million. Our customers in Ohio and in Michigan. At the same time, I also took responsibility for another service that they had, which was medical coding. I had a medical coding pool, which we tried to do here, we have a medical coding service now, here.

        What was unique, the unique thing that made it successful in Cleveland was that he had concentration in a small geography of, you know, let's say 60 miles by 40 miles where someone who worked at this hospital might want to moonlight at night and a couple extra bucks on the other side of town. I had a person who was the director of that program, that knew every coder in Northeast Ohio. We had a very successful service, but we basically helped hospitals with their coding backlogs, even in those days. I mean, coding backlogs were always an issue.

        I was responsible for that function there. What I really liked about that is, back to my experiences at Sinai, was I was external with the organizations, dealing with multiple organizations, and I liked that, I liked being an outsider. Not being, necessarily, inside the hospital. I said "I'll never really go back to being inside a hospital again."

Bonica:

        Okay, you made that call while you were at the Hospital Association?

Vicenzi:

        Yeah, I'm going to go back to being inside a hospital again. I really liked, you get to see multiple organizations, meet with multiple CEOs, meet with multiple directors. Really, it jus broadens your perspective on a lot of things. That's why I really believe that sometimes, executives treat suppliers as vendors, you know, as opposed to treating them as partners. Suppliers, if they're a good vendor, and they're smart, they've got perspectives that you don't get in an individual organization because they're out in the marketplace, talking to multiple organizations, they see what goes on there. They bring that kind of value, and that experience to the table when they talk to you. Anyhow, I really enjoyed my role there, but it was a little restrictive in terms of my autonomy.

Bonica:

        Okay, how so?

Vicenzi:

        Started understanding what autonomy is about, which is "I really like the work you're doing, I'm going to give you a $2,000 increase next week?" Things like that, which I didn't have the latitude to do. I didn't have the latitude to do things, I had a lot of latitude to do a lot of stuff with kind of, you know, in terms of managing the people that have to service my customers. I think it was the organization, it's just that's the way it was, it's limiting in that regard. While I was there, I got engaged with the national trade association that represented health industry, represented group purchasing, which is called the Health Industry Group Purchasing Association.

        I attended one of their meetings, and I don't know, the director of the organization took a shining or a liking to me, and you know, he asked for me to sit on the committee. I sat on his committee, well, eventually, I ended up running through all the chairs there; I became treasurer, and then chairman and then past chairman and I did the whole-

Bonica:

        This is the national organization?

Vicenzi:

        Yeah, it's a national, Health Industry Group Purchasing Association. We were a small piece of it, from a purchasing perspective, we had a lot of big players that we part of that, but the value of those relationships and that networking. Right? The [inaudible 00:28:03] of that networking and those relationships got me the job in Maine. Because a recruiter from [inaudible 00:28:11] Keefer, obviously was talking to other people, the Group Purchasing Association, who is around? Who might be interested in these kind of opportunities? Synternet has a big place in group purchasing. That was our first foray as a collaborative organization was group buying and group purchasing. The recruiter finds me and says "Hey, you know, I've got an opportunity, and I had started, like I said, I talked a little" ... It's time for another move, big opportunity, seven years.

Bonica:

        Five, six, seven, years.

Vicenzi:

        I'd been there seven years, and I got an opportunity in Maine. Maine. I go "Yeah, I think I know, that's north of Massachusetts, I think I've been there once." Which is, I mean, well, you know, you could be the CEO of this organization, and I go "Well, sounds like an opportunity I need to think about." I had never really thought about being the CEO of an organization.

Bonica:

        That was not something you were aspiring to or pursuing?

Vicenzi:

        I wasn't aspiring to it, I was just aspiring to certain things that I aspired to. Have a responsibility, have an autonomy, have, really, opportunity to make things happen. I mean, and having been in a number of organizations going "You know, I can make those kind of decisions, just like all those guys did, why can't I do that?" I mean, I could make them, I could make them just as bad or just as good. I'm hoping I'm going to make more good ones than bad ones. I wasn't aspiring, looking for that kind of ... I said to somebody, I said "I could've been a CEO of a popcorn stand, but the idea of having my own responsibility and autonomy to make something happen, really, really appealed to me.

Bonica:

        When that offer was made to you?

Vicenzi:

        When that offer was made to me, and so in February of '99, I had been up here once or twice and they said "Well, we need to come back, the next time you should bring your wife with you. You should probably bring your wife." We came up here on Valentine's Day of '99, actually, it was Valentine's Day weekend, I said "Well, you know, you've never been to Maine, why don't you come with me? Hey know, who knows where this is going to go." I still was not like "They're going to pick me." You know, I had to go through a round of interviews again, and she came up here, and she kind of goes "You know, I'm thinking I could live here."

Bonica:

        Yeah, right.

Vicenzi:

        It was like "You think so?" Within a month of that, they'd made me a job offer, and I had decided to come to Maine. In April of '99 I moved here. Left my family back in Ohio, we had moved back into the house we had bought, after I had worked at GCHA for a year, we had moved back into the house. My son was seven, it was a good time to move. My wife, she was really good about the move in terms of "Yeah, I'm excited about doing something different." It was a real challenge when we first got here, for both of us, from the perspective of a big relocation is like that, I knew the dynamics, I kind of had an idea of what the dynamics were of being CEO, of assuming responsibility for an organization, I could rationalize that, like, write notes about how I was going to handle this, how I was going to introduce myself to people, you know, all those kinds of things.

        From a business perspective, that wasn't as much as a challenge as the personal situation of uplifting and breaking 20 plus years of relationships and personal relationships and friendships and all that kind of stuff; being dropped in a new area. Like, no.

Bonica:

        You knew nobody and been here once before?

Vicenzi:

        Yeah, right. First [inaudible 00:32:13] it kind of was times I go "Man, I hope this is the right thing to do." Back and forth, but we go through that, and I think interestingly, I always attribute part of the positive aspect of having a child later in life, because I was 42, my wife was almost 40 when Chase was born, was that he really was, that's how we built our relationships. Through school.

Bonica:

        Yeah, right.

Vicenzi:

        You know, if we didn't have a child going to school, because our older daughter was grown, you know, out of the house and living in New York City when we moved there. She's 40 now, I mean, it's just that whole thing. We settled here in, like I said, '99, and I came on board. Synternet was a hospital co-op that had been started by the smaller community hospitals in the state to collaborate and gain economies and efficiencies.

Bonica:

        Particularly for purchasing, right?

Vicenzi:

        For purchasing of any kind of goods and services. There was an underlying animus regarding the larger organizations of the state. At least in Maine. East of Maine, I mean, up in Bangor Maine Medical Center and Port Whitman. Basically it was always like all they want to do is dominate, take, et cetera, you know, and they didn't really want to do anything for us. This was kind of a little bit of a ... You know it would be kind of like ... I know it was collaborative, and they did a lot of collaborative other things besides purchasing. They have collaborative groups looking at different ... You know, they had a good collaborative group that looked at pharmacy medication [inaudible 00:33:52]. They brought together their pharmas to look at medication, this was back in the nineties. They were tracking them in a card-punch kind of driven computer system. I mean, they would do some innovative things to try to get on top of the things that they needed to get on top of as that collaborative organization.

Bonica:

        When that started, they're doing that through Synternet?

Vicenzi:

        Yep, through Synternet, yeah. When I came on board, there in '99, the collaborative was about 12 years old and it had begun to wane in terms of people, members leaving, and not paying their due, not wanting to pay dues, because it was a dues-driven organization, they ended up, we had services that we had started a few services, and the Maine Health had started, and it had actually brought Brighton Medical Center, which was here in town, and they were in the process of bringing ... They brought a couple other hospitals, Stephens Memorial out in Saint Andrews and miles up in [inaudible 00:34:51] and the [systemization 00:34:53] had begun, it was a wave of systemization, and so some of the smaller guys were like independents.

        We're in the independents, no matter what we can do, we need to do everything we can do to retain our independence, and so that's why they decided to continue or sustain Synternet. My vision when I came on board was I think we've tried to delve into areas that are not within our competency. The things that we're really doing well are the things that are administrative, and really lend themselves to the economic consolidation services and expertise that you can share. You know, the clinical engineering, the group purchasing, some of these other clinical things we were trying to ... At the time they had tried to do a ... What did we call it, [inaudible 00:35:39] ... Community Health Improvement Initiative across all their entities. Well, you know, community health is something that's locally driven. You can't aggregate stuff across ... The idea might have been sound, it might have been, but the devil is in the details, it didn't work.

        They spent a lot of money on consultants and trying to get plans, and then they also tried to put together a managed care network to compete with the contracting issues that were going on in the prospective payment system, and they've got a managed care network without an anchor, tertiary care hospital as one of your anchors. How can you have a real good managed care network, provide services ... I won't say initiatives have failed, but they really, from a financial perspective, they lost a quarter of a million dollars a year before I got here. There was still this need for someone at hospitals, that we need to maintain this positive ... The positive aspects of this organization and this collaborative focus. That's when I came on board, and so it was really a turnaround in a way, and a turnaround in [inaudible 00:36:47].

Bonica:

        How did your experiences prior to coming to Synternet, what do you think best prepared you for the role that you then took on in 1999?

Vicenzi:

        I think it's a little of everything, because I think the engineering mentality or the process focus just lends itself to problem solving, no matter what the problem is. The problem here is how to sustain this organization and find new ways to grow it and build new services, so it's a problem. I'm analytical, engineers [inaudible 00:37:18] is a problem what do we do? What are the steps we need to take? How do we implement the steps and put together some information and assess it, and if we see how it works, and if it doesn't work, let's kind of modify the process and come back and try again. That whole engineering discipline or mentality, I think, having worked inside a hospital, particularly, it was a real value to me, because I've had people who've worked for us in this organization, over the past X number of years who have come to us from not having been inside the customer.

        I really understood the inside of the hospital.

Bonica:

        So it was important that you had that stint?

Vicenzi:

        Yeah, as an employee.

Bonica:

        Yeah. At Mount Sinai.

Vicenzi:

        Yeah, right. I mean, I really understood the inner workings of a hospital, and particularly, all this kind of administrative service related functions, which is what we were talking about. We're not talking about radiological functions here, or like clinical. Then, the third aspect, I think was the experience at Greater Cleveland Hospital Association dealing with services provided to a diverse group of organizations and hospitals, not providing service from a supply chain organization within a hospital, but services to multiple organizations, and multiple customers, and understanding customer service and what that means, if you want to be the supplier or program of choice for a hospital. I think all that combined, to make, really, it's interesting when I look at it. You know, all those three elements, the analytical engineering piece, the hands-on experience inside a hospital, and then the third piece of having worked in the setting, where I dealt with multiple customers.

        We've frequently looked ... We sometimes look at talent, and some of our services. This is a good example, in our credentialing service, Arena, we provide ship credentialing services for like 40 to 50 organizations. Frequently, some of our customers end up being medical staff offices at the hospital, and medical staff offices go through transitions and turnovers, and frequently, Cheryl Shilke will tell me, she goes "Well, what's her name at Joan at X, Y, Z hospital is the one to there." I go "Wow, jeez, I thought she was a really good customer [inaudible 00:39:50] I really liked her." She goes "Yeah, well, you think she'd be a good" ... She goes "Not necessarily."

Bonica:

        A good hire first.

Vicenzi:

        Yeah, she'd be a good fit for us, not necessarily. Because she's accustomed to doing things ... You know, X, Y, Z hospital's way. X, Y, Z hospital's way, not our way. Cheryl has found greater success hiring for attitude and basically good skills and trending them, and then hiring people with the expertise from the hospital and the credential arena.

        It's kind of like ... I think that's an interesting thing, here. I think it's important for people who work for Synternet today, it's great if they have the hospital experience. That's a plus. That they have to have the attitude that's really customer service or customer focused first. Customer centric is the number one thing for us. That is the driving force. If your customer base is 15, 20, 30 organizations, they're all equal. They're all important. They're all important, and so I think that that's a different mentality, and I had that situation a couple of years ago in my coding arena. I was looking at my director of coding who is starting our program, decided that managing a revenue-generating, even though she was extremely adept and well-respected in that arena, this was not her bag."

        Being responsible for a revenue line, employees and generating multi-revenue and servicing multiple customers was not her bag. My question is "Who in the Him community within the state of Maine could fill your role?" It's like not too many people. Because you want a person who is not just an expert in that discipline, you want a person who has management and leadership skills to run run a small business, basically. It's a little different. That's the kind of people that we need to have in this organization, and we need to have employees who are very ... Have a positive, customer-centric attitude. Attitude is key.

Bonica:

        In 2000, shortly after you came, Synternet actually joined up with Maine Health, is that correct?

Vicenzi:

        Yes.

Bonica:

        What was that strategically? How did you make that decision?

Vicenzi:

        Yeah.

Bonica:

        What did that mean for the organization?

Vicenzi:

        Yeah, so, once I got to the state, my chairman at the time, was CEO up at Franklin Memorial, sat down with me and he said "You know it's a collaborative co-op model we have." He goes "To get this member-based dues function. You need to figure out how to do business with any organization in the state who can match up to the services that you provide." At the time, we did no business with Maine Health or Maine Medical Center, Maine General, Maine General, any of the big guys. I mean, it was a small guys co-op.

        I took about, that first year, Synternet had a good reputation, we had a good brand recognition within the state. You know? Not only among the smaller hospital community where that was our forte, people knew who we were. Really, I met with just about every CEO in the State of Maine that first two years. You know, I said, they can, working through my notes, talking to my chair, talking to a couple other members of my board who were saying "Jerry, you know, you've got to figure out how this evolving force in the State of Maine, Maine Health can be in our camp, really." I had a meeting with the key leaders at Maine Health, and made a presentation about who we are, what we do.

        I said "You know, we're looking for partnerships in some of these key areas that we work in, clinical engineering." The CEO at the time Don McDowell, who preceded Bill Garrett, said, he goes "What's new now? You know, we've tried to approach you guys in the past about trying to work together and were kind of like we're buffed." I go "That's the game." This is a new world. I go, I really ... Our survival goal in Florida is going to be built on our ability to have scale, you know? We can't get enough scale from just if we don't work with larger entities in the state. Whether they're individual like yourself, or have broader members, membership.

        The Maine office, in the process of ... They know how to create the right kind of control in their ownership and governance structure, to give them the kind of ownership or control they want, but they don't necessarily control, day-to-day, what you do on a day-to-day basis. I mean, the way they had structured most of their arrangements, and they were examining that, now, 15 years later, or, I mean, 14 years later is we never really consolidated assets. I mean, Maine Health is a system, and I guess most hospital systems are not consolidation of assets. They're basically member controlled, controlled by a large entity of a board and things like that, but not actually consolidation of assets.

        Maine Health, familiar with the model, understood the issues of control and came back to us with a proposal that made Synternet an entity of Maine Health. With the same status as any of the hospitals, where Maine Health would have, basically Class A shares, which they do. Their remaining hospitals would have Class B shares, and the only difference between the Class B and the Class A, it has controlling stock. If the company wants to close down, be sold, or you borrow any real big money, they need to have a say in it. Otherwise, what they do is they delegate the operation of the organization to the Class A and Class B shareholders equally. My board is equally composed of four Class A members, and four Class B members.

        There is power, Maine Health is the Class A shareholder and the owner, I mean, technically, but everybody has equity.

Bonica:

        Their Class B holders are more like stakeholders rather than-

Vicenzi:

        They're stakeholders, but I think that the intent at the time was "Let's keep them at the table as a stakeholder and not just say 'Well, we'll take over Synternet.'" I mean, they could've done that. They could've easily said "Not only are we going to match the capital that's in the organization, but we're going to pay you back for the other capital and we're going to own the whole company." I think the idea was "Oh, keep them at the table as stakeholders." Actually, it was a good model. We revisited it a couple of times since then. We said we'd revisit in three years. I remember three years after the [inaudible 00:47:06], and they said "No, this model is working. It's a good model, let's just keep it the way it is."

Bonica:

        What's the benefit of having the Class B shareholders on the board? What's the benefit to Synternet and to the shareholders?

Vicenzi:

        The benefit to the shareholders is that they're involved in the decision making. I mean, they control the organization. I mean, our strategy, our plans, our funds, everything. I mean, they're the ones who drive it. Class B or Class A, the board members have equal. It's been a good structure. I think it may undergo some fundamental reevaluation in the next three to five years, here, or two, because the number of independent entities in the state of Maine is shrinking rapidly.

Bonica:

        Right.

Vicenzi:

        It's not unrealistic that at some point, Maine Health would assume all, but as of right now, we're still working under that model and I think our [inaudible 00:48:05] is to work under that model for a period of time.

Bonica:

        Interesting, okay.

Vicenzi:

        The idea to bring Maine Health on board was access to more scale and state.

Bonica:

        You could then sell to Maine Health.

Vicenzi:

        Build more services. What it did for us was kind of bring more scale to the table; not guaranteed scale, because I can tell you that we have sold every one of our customers and every one of our services based on what we do and how we do it, and we deliver.

Bonica:

        Maine Health doesn't push.

Vicenzi:

        Not because Maine Health said "You're going to do this."

Bonica:

        They'll use Synternet.

Vicenzi:

        Right, they've never done that.

Bonica:

        Okay, so it's still up to you to go, even a Maine Health entity, it's still up to you to say "Hey, we'd like you to be a customer." And they can say "No."

Vicenzi:

        Bill, can you call Tim over at that hospital and suggest to them that we've got a great proposal on the table? Sure Jerry, that's fine.

Bonica:

        Okay, yeah. A little bit of an inside advantage.

Vicenzi:

        Just a little bit of an inside advantage.

Bonica:

        But they don't have to buy from you?

Vicenzi:

        They don't have to, I mean, in some cases, they haven't. Much to my [inaudible 00:49:06] staff's like "Why aren't they doing this." I go "Because, you know, they have no other choice. I mean, it's a free market, we operate in a free market." What's happened since the Maine Health is, credentialing, was something we never did before, and we assumed a staff of four people that they had in their PHO, that used to do the credentialing work for their PHO.

Bonica:

        A PHO, for listeners at home.

Vicenzi:

        Physician/hospital organization.

Bonica:

        Okay.

Vicenzi:

        A creation that some hospitals, organization that many hospitals created in order to jointly contract with third parties. Where you have independent physicians who aren't employees of the hospitals, so you didn't have a real contracting arm. In order to do that, you needed to put together an organization, so the physicians interests are represented in the PHO, the hospitals interest here, and then they jointly contract through the two organizations with third parties and things like that.

Bonica:

        Gives more scale when they negotiate.

Vicenzi:

        Yeah, more scale, so they're not negotiating the individual [inaudible 00:50:03] so the PHO gives doctors more leverage, it allows the hospitals and the doctors to go jointly, you know, to the third parties. We took those folks over and so now we've got, what, 16 to 17 people doing credentialing work.

Bonica:

        You've quadrupled the size of your staff?

Vicenzi:

        Yeah, we've quadrupled the size of it, we do it all over the state, and we do it from New York all the way to Fort Kent, up through Maine General is our customer, we even do it for Central Maine Healthcare, which is the dynamics between Maine Medical Center and Central Maine Healthcare are not positive.

Bonica:

        This is competition.

Vicenzi:

        Yeah.

Bonica:

        Maine Health's competition but you're selling them services?

Vicenzi:

        This is something that sits in this box over here, it's not competitive, we know [inaudible 00:50:46] is competitive. Actually, it's a positive for providers. In this case, we don't get too much of that, but we get overlap, here in Portland in particular, where if you're a provider, and you're playing for privilege, most independent providers here work at both Maine Medical Center and Mercy. You've got to get credential to privilege at both organizations, so we facilitate that process. You do it one time with us. Because we coordinate it so it's on your birth date, and so we have it set up with both of the organizations that on the birth date this guy will come.

        He submits his application and once [inaudible 00:51:26] have it, they send it at different times, and different ...

Bonica:

        Sure.

Vicenzi:

        It's a great administrative simplification for providers, sometimes, today, are very overwhelmed by the administrative details that they have to fall to attend to. That service is going fabulously, and then we started ... We do things based on the market, what the market tells us to do. Transcription was an item, actually, that was on the radar screen of Maine Health's administrative integration targets. I said "Oh, transcription?" I had a list of opportunities and I said "I'm willing to pursue that." To Bill and Frank at the time, and I said "Let us." We pursued it and did the due diligence, collected data from all of the hospitals around the state, and put a pro forma together and decided our best effort here is to try to create a transcription service. This was like 2004, but it took one of our smaller entities, Franklin Memorial to step up to the table and say "Jerry, I'm going to give you my department of eight transcriptionists, outsource them to you, and you sell the service back to me."

        It took somebody, really, to step up, that's what it takes. It takes enabling scale of some sort to get one of these services off the ground.

Bonica:

        This was a group that was existing? A team that was already existing at a local hospital?

Vicenzi:

        At a local hospital, right?

Bonica:

        You took them over?

Vicenzi:

        I took them over, and they stayed there. They [inaudible 00:52:53] stay, yeah, we moved them off-site. Yeah, we moved them off-site. That was one of the stipulations was if you open an office, it's going to be in our community, here. So we opened up the office in the Wilton Bass Shoe Factory, and moved in there and had renovated some beautiful space there. Actually, it was magnificent space. Real high ceilings, you know, all that great old pine, you know, raw pine, and it was exposed. It was beautiful. Oh, look, the river, the creek, it was beautiful space. Well, within a year, everybody was home.

Bonica:

        They were working from home.

Vicenzi:

        Yeah, within a year, year and a half, or so, we leased the space and we realized that the model for growth was not going to be locally there, because the only way we're going to grow this business was if we picked up a customer in Camden, which was our next customer, or Rockland, to Penn Bay Medical Center, those transcriptionists weren't moving from Wilton, so we had to figure out a way.

        It became a home-based model. We kind of became a home-based model very quickly out the door, and today, we have almost ... Well, we have almost 200 employees in that division, in that area.

Bonica:

        In transcription?

Vicenzi:

        Yeah.

Bonica:

        Scattered around the state?

Vicenzi:

        Around the country.

Bonica:

        Around the country?

Vicenzi:

        Yeah, we've gone national.

Bonica:

        You kind of placed them close to a facility that they're-

Vicenzi:

        Not necessarily.

Bonica:

        Okay.

Vicenzi:

        Not necessarily, no, it's just it's where we can get talent, and our challenge there is finding people ... Most of these people understand how to work at home, because they've done it. Our challenge there is finding people who are very productive. Meet high productivity standards and quality standards, because that's what we sell. Our ability to sell to a hospital is based on our price, and if we can't be productive, then we can't make our margins.

        It's a very challenging, narrow-margin business. The wheels always keep turning, and in response to HIM staff, HIM people in the communities, they go "Wow, if you're doing this, why don't you do coding work?" You know, it's just a logical thing, you know? We've assessed that and about two or three years ago, four years ago, the IT dynamics got to the point where it's possible for staff to work remotely. Your access is improved, but you've got to get access to all the patients' records through an IT connection. A lot of hospitals online access the records, or online, so, it was a real challenge to work remotely, but eventually, we were able to start the program and all our 95% of our [inaudible 00:55:40] work remotely from home. They're linked in to the hospitals system to do coding work.

        Again, response to the marketplace, listening, understanding the dynamics, being able to offer a product at a price point that's below the national firms that do that kind of work. It's really important because why are we buying [inaudible 00:56:03] ... We're price competitive. That one, you know, it's the same thing in the market. You know, we listen to the market with regard to our provider enrollment services.

Bonica:

        Let me summarize, kind of, the flow as I understand how Synternet has gone. You start out as a group purchasing organization, you added on biomedical equipment repair, worker's compensation, you then add on credentialing verification, which we talked a little bit about. You added on transcription, and then you decide to exit group purchasing. What was the decision point there? Why? Because that seemed like that was kind of your personal background areas?

Vicenzi:

        Couldn't be a big enough player.

Bonica:

        Couldn't be a big enough player. All right, so you couldn't get the scale?

Vicenzi:

        Couldn't get the scale, couldn't be a big enough player. The systems themselves, were creating their own internal GPOs and working with nationals. It was like "Right, how could I compete with Maine Medical Center when Maine Medical Center is part of Maine Health, and then they have the smaller entity?

Bonica:

        You weren't going to be able to generate enough scale.

Vicenzi:

        We weren't going to be able to.

Bonica:

        The big thing for you is finding things that you can scale. Then you have to guess on the things that you can't. Scalability.

Vicenzi:

        Scalability and size. You know, scale is great, and I can tell you, to a certain point, and after that it becomes almost like "This is a [inaudible 00:57:26] easy to scale." Because at a point, you know, you've got to add infrastructure, you've got to add support. I mean, scale is good. Don't get me wrong, scale is good, but that's the key. It needs to be scalable and build-able, right?

Bonica:

        Then you added provided enrollment services?

Vicenzi:

        Right.

Bonica:

        What is that?

Vicenzi:

        Provided enrollment services, if you're an independent or any kind of a practitioner or a physician or an allied health professional, and you need to get paid by third-party payers, you need to economically credential with them. You need to ... Every third-party that you want to get paid for, you got to fill out their form, and send it to them.

Bonica:

        So that they know you're actually a credentialed provider and that [crosstalk 00:58:16]

Vicenzi:

        You know, you [inaudible 00:58:17] provider and they can pay you and will pay you.

Bonica:

        This is a service you provide, one-stop shopping, essentially?

Vicenzi:

        Right. The hospitals that we work for, we will, if they have a new provider that's employed by them, we'll enroll them. With all the different third-party plans that are affiliated with the hospital, we'll take care of it. What we do there is we leverage most of those customers, I think 90, I mean, are upstream customers of ours, in credentialing, we've captured like 80% of their data already, so now we're verifying it and we're augmenting it with specific-

Bonica:

        There is a synergy.

Vicenzi:

        Yeah, with specific information that needs to be added for the third-party billing, because in our credentialing database, we don't necessarily have all the practice addresses, the locations, who in the practice might bill for services. Those are the kind of things that you have to do, and if a practice is applying to get paid from services from Anthem, they got to fill out these forms and they got to answer all these questions. What we've done, effectively, is we've automated that. I mean, we've got the data, and then we populate those forms automatically.

Bonica:

        All right.

Vicenzi:

        This is not magic, this is not rocket science.

Bonica:

        Right. It's more convenient to have ...

Vicenzi:

        It's convenient.

Bonica:

        Have you, who, you're already doing their credentialing stuff, it's just more convenient, rather than setting up something at their facility to do it, they hire you to do it.

Vicenzi:

        It expedites the process, and it provides a good tracking mechanism, as you've automated the data now, and so you can get reports of ... I sent these applications to Anthem or to Medicaid, or to [inaudible 01:00:05] Pilgrim 30 days ago, and I haven't gotten a response back, in terms of whether the ... You know what I mean? You've got a tracking mechanism. In most organizations, that is currently done ... Well, if it's an independent practitioner, they're doing it on their own. If it's an organization or hospital, it's typically done, maybe, in an organized fashion, but a lot of times it's fragmented. You've got different practices the hospital has acquired over time, and so the practice managers in each of the organizations are still doing that.

        I mean, trying to aggregate that function, if you go to a hospital, it's not easy to find where that function is. It can be disparately dispersed across the organization, so, we provide, really, it's an excellent service. It's kind of big growth opportunities for us.

Bonica:

        What's your theme for ... What is Synternet really focused on now? What's the strategic direction you're taking the organization?

Vicenzi:

        You know, our strategic direction is five-fold right now. One, it's sustained growth in each of our businesses. Because we think that those two things, number one, that it builds scale, and it solidifies the businesses that we have, and number two, it broadens our expertise, because we learn from new customers. We continue to grow.

        What I call big things for us are customer service, customer intimacy. We've determined there are three things that you can distinguish yourself competitively on: low-cost provider, high-tech answer, customer intimacy. We're not necessarily going to be a low-cost provider, because we're not going to be the Walmart of anything we do. I don't have Bell Lab, I don't have Rand Research doing, but I can be good at being the best with my customers in terms of, I call it customer intimacy. Knowing the customer, responsiveness, follow-up, timeliness, and so we're really a big force across all our service areas to focus on the customer relationship and customer engagement. Similarly, the other aspect of that is I tell people the customer is first, employee is right there.

        The second piece of this is our employees. Employee engagement is really high up on our strategic priority list right now, because without good employees, I have nothing to deliver. Without a customer, I don't have a service. It's kind of [inaudible 01:02:44] everybody that's prior service, but without the employees I can't provide a service, because those are our two big ... That's how big a resource. Our resources are employees, and then we glue it together with some IT stuff, which, that's a challenge in and of itself, managing IT.

        Out growth is different in each of our individual businesses, depending on where they are. You know, what they do and where they serve. You get different reaching strategies.

Bonica:

        You're going out beyond Maine, though?

Vicenzi:

        Absolutely. Our market, yes. Actually, our plan this summer-

Bonica:

        Does that depend on what you're ...

Vicenzi:

        Our market is wherever the opportunity presents itself, where we believe that ... I think we were [inaudible 01:03:27] in the strategic plan, what we believe our competencies in are, and our capabilities can continue to provide the service effectively. We're not limited by geography. Only limited by our capacities. Capacities are limited by talent.

Bonica:

        Talent?

Vicenzi:

        Recruiting talent, finding good people, and secondly, by just resource constraints. IT, IT is always a challenge. Especially in today's world. Cybersecurity issues, you add another layer of overhead. You know, another layer of cost to protect and mitigate against those kind of risks, because we're totally IT-driven.

Bonica:

        Yeah, and if you're dealing with coding, you're looking at patient records and all. That's very important stuff.

Vicenzi:

        Right. All those kinds of things. Those kind of infrastructure challenges, they're infrastructure, but they're really strategic for us. I mean, if we don't focus on those, we won't be ... The internet, internet accessibility for us is a challenge, because we don't necessarily control the internet accessibility for any of our employees. I mean, our employees are-

Bonica:

        If they're working from home.

Vicenzi:

        They're working from home and they could be with an internet carrier ... We've got transcriptionists that use 25 different internet carriers. I mean, we don't have any control over where the internet carriers are, or that they have.

Bonica:

        Sure, sure.

Vicenzi:

        You know, some of them have to get to us. We don't actually have technology now ... It's amazing, we have software that we can put, what we call, is an agent, on an individual's machine, and it will show us all the points between here and our data center that they stop. I mean, it's usually more than eight. It's more than eight. It's at least eight usually, because they'll go from ... Actually, you could go from Maine to Massachusetts to New York and then back to Maine in order to get here, on the internet backbones that are out there.

        That whole issue, I mean, a lot of our model is based on the internet. I mean, and if they're not investing in the infrastructure to build the bandwidth and the capacity on that internet, we could be really challenged. We've seen, the past year, we've had increased issues with our remote workers and internet access.

Bonica:

        About how many workers in total in Synternet?

Vicenzi:

        About 270 now.

Bonica:

        270, wow. Okay. What would you say are some of the most difficult strategic decisions you've had to make as CEO?

Vicenzi:

        The difficult decisions I've had to make don't have to do with strategy.

Bonica:

        No?

Vicenzi:

        They have to do with people. They have to do with developing people to meet the leadership or the demands of their position or moving them out of the organization. Those are not easy things, those are difficult things to do, especially when they're senior people. When you realize that it impacts personal lives and careers, and a lot of different things, those are real, real difficult decisions that any CEO struggles with. My sense is that, in retrospect, as I look back on my career, I've generally made those calls way before I'd made the move. That's probably one of the ... I'd call it one of my blind spots is giving people more opportunities when I know that I really should be making the move.

Bonica:

        Okay, so you wait a little too long.

Vicenzi:

        They may wait a little too long.

Bonica:

        Okay.

Vicenzi:

        I mean, difficult. I mean, I guess that comes out to who you are as a person, and you always try to give people the benefit. I don't know how the benefit of the doubt, but you want somebody whose cases I'm describing have to do with somebody just not ... They're not the person you need to lead a particular area, or they're not doing ... You know, those are very difficult decisions. I mean, it's always a difficult decision to decide if you're going to make an investment, or step up and buy. Like, you know, we had a vest in provider enrollment, so we had to make a capital decision. Like, we really wanted to get into this business. I wanted to get into this business, we got to buy the technology infrastructure to support it, and we have to hire somebody. We have to invest whatever it is, you know? A couple hundred thousand dollars, knowing that we didn't really have anything coming in yet?

        Those are difficult decisions that you make based on ... Hopefully you do the due diligence and you take all the factors out, I mean, you have to make the decision with incomplete ... We don't always have all the data.

Bonica:

        Right.

Vicenzi:

        You know, you have to go with ... Really, I mean, the services we've focused on and built, we haven't had to back away from them. They've generally ... We generally know. We feel the market wants it, and there's an opportunity and we know we just have to fill it, and then we have to build the scale to kind of support it. I think the people decisions are the toughest. They're really difficult.

Bonica:

        What's a day in the life of the CEO of Synternet like?

Vicenzi:

        I think it's like ... It would be like three things. A lot of, for me, it's a lot of one-on-one interaction with my leadership team in either routine one-on-ones that we schedule every other time, or to follow up on a specific thing, initiative, that we're trying to get ... It's a piece of that. The second piece is the external contact, and talking to customers, meeting with customers, seeing customers. I really like to go on ... I love it when I'm on the road. I love it when I'm not in the office and I can say "I've been on the road today, I was talking." And I get energized, you know?

        The good news is when I usually go see a customer, I'm like going in there, and they go "Jerry, I haven't really talked about this problem I've had with one of your services." God bless me, I mean, I've got great people who do great work and, in general, we're just having a very good, positive conversation about what's going on, what their future is, where they are. That's a big piece of what I need to do and what I do. Like, Tuesday, I was up in Augusta meeting with someone from Eastern Maine Healthcare about collaborative opportunities between Maine Health and Eastern Main Healthcare, which, that's part of my, one of my, something that was sort of my projects that I'm working on. That's an external kind of thing, you know? I enjoy doing that.

        I came back, I had a meeting in the afternoon here in the office with two of my leadership teams. Another one-on-one meetings, and then I spent the rest of the day, probably working on projects that I have. You know, one of the big projects I have right now is moving our offices. We're going to be moving our offices from this building.

        I do a little of everything. I really enjoy the external customer relationship stuff a lot. Managing my leadership team work room, my leadership team, and then thirdly, just a laundry list of products. You know, I'm that one who issues the succession plan and all that kind of stuff. Which, I need to get to my board by May.

        Yeah, it's a blend and I kind of like that. It's not one thing. It's not one thing, you know?

Bonica:

        What are you worried about most? What keeps you up at night when you're thinking about the organization? Is that only one thing, or is it change?

Vicenzi:

        No, no, no, no, no. I think the thing I worry most about is financial performance in the organization, being able to sustain in this environment where my customers' revenue base is not growing.

Bonica:

        Right, you're selling to an industry that's ...

Vicenzi:

        It's like this.

Bonica:

        Tough times, right.

Vicenzi:

        It's like this if we're lucky, and most of them are going like this.

Bonica:

        Yeah.

Vicenzi:

        They're on a down slope, and so I'm downstream from that. It's difficult ... I mean not difficult, I mean, our challenge is to continue to grow value in our organization and maintain that margin of profitability.

Bonica:

        They're hiring you because they're being squeezed, right?

Vicenzi:

        Because they're getting squeezed. You know, they're hopefully hiring us because we're getting squeezed, and we think we can do it in a better way. I think that ... Because it's not this stable environment, it's a very dynamic, changing environment. I think, financial profitability, and the other thing that does wake me up occasionally is IT issues. They just do.

Bonica:

        Any security kind of stuff?

Vicenzi:

        Security stuff, or the glue, or that whole thing. I mean, last year, this is a ... I just relate this incidence to you, and I talked about this, a number of physicians in Portland had their ... There was a big national thing with this too, had false tax returns filed, and it just happened. It popped up on the radar screen of a number of docs within the close community, or Portland within a short period of time. Who has all the physician information in this town? Synternet. I mean, we came under scrutiny for about two months. I got to tell you, my IT folks are my credentialing people, did an unbelievable job.

        I mean, there was no way to prove that that's where the data came from. Eventually, though, you know, I don't know, one of the national credit bureaus, one of the big national [inaudible 01:13:47] was, but that kind of stuff keeps me up.

Bonica:

        Yeah, sure.

Vicenzi:

        That kind of stuff really keeps me up.

Bonica:

        Sure.

Vicenzi:

        Because, to my IT guy, eh goes "We can mitigate risks, but we can't eliminate them. If somebody really wants to get you, they're going to get you."

Bonica:

        What surprised you most about the CEO role once you stepped into it?

Vicenzi:

        It's lonely at the top. It's lonely at the top.

Bonica:

        What do you mean by that?

Vicenzi:

        I never really understood what that meant, until I was a CEO. Through a very ... You don't have ... There's a lot of things I can't share with my management team. There is a lot of things I can't share with my board. I share with my management team, I'm really talking to them about things that might impact another one of their colleagues, or I can't talk about performance issues related to whatever their colleagues. If I share stuff like that with my board, it's like "Oh, jeez, that person works in your organization, and you have those kind of resources." I mean, you know, I just really ... It's difficult sometimes, or it's ... Even this whole issue of succession. Because once you tell somebody you're leaving, that's the date that sticks in their mind. I haven't given them a firm date that. They know that. They're waiting for something.

        I mean, it's just it's lonely. You know, I don't have a lot of people that sometimes, I can talk to about things that are front and center on my mind. I have joined a CEO networking group called Vistage. It's a national organization that provides a forum for CEOs to get together on a local basis, and they're huge. They've got like seven or 8,000 members across the country, in different regional networks that are set up and chaired by what they call a chair, a Vistage chair in the region. You get together monthly, and generally the format is a speaker of some sort of an important topic, whether it's growth, employees, business continuity, going green, and then what we do is we process issues, and everybody checks in as how they're doing in their personal, professional life, and where we are, and then we go down the list and people say "This is one of my big issues that I'm dealing with right now."

        We list them out, and then we prioritize them and we decide, based on that, "Well, we should help Mark talk about that issue and we can process it with a group of other CEOs."

Bonica:

        Nice, okay.

Vicenzi:

        It's nothing ... It's not magical stuff, it's peers networking and your ability to basically ... I mean, confidentiality, it's the ability to share whatever you're thinking. You know, I really can't tell my management team on my board the strengths and weaknesses of all my management team. I know, but I'm not sharing it with all my board members. I mean, some of them are my customers. That's my big challenge in that regard is that my board are my customers, also. I've got to really be careful of what I say to them sometimes. That's a real challenge. That's probably the most surprise ... I mean, I really understand when they say "It's lonely at the top." I really understand that now. I really do.

Bonica:

        If you could go back in time to 1999, and meet your 1999 self, what advice would you give him as he stepped into the role? What caught you by surprise, maybe?

Vicenzi:

        Yes.

Bonica:

        All right, so you said lonely at the top. But what would you tell him "Hey, be ready for this."

Vicenzi:

        I think, you know, you have to ... I'm tolerant. I think you've got to be tolerant of ... I mean, I'm pretty good at this, though, I'm tolerant of the politics, you know, and the system dynamics that go on, and the slowness of people to react, and I guess, if I had to go back, I'd go "I really should have gone with my gut a few more times." My gut told me what I was supposed to do a year before I did it. Like I was telling you about people.

        It's really, now, I'm 65 years old, so I finally figured that out. I mean, I'm almost retired. It took me a lifetime to figure out that my gut is in a bad ... The gut is not, my gut is not bad, my gut is pretty good, it usually tells me what I should be doing, but, I mean, it takes ... You know.

Bonica:

        Trust your gut.

Vicenzi:

        Trust my gut.

Bonica:

        Your advice to yourself 17 years ago or 18 years ago.

Vicenzi:

        Trust my gut.

Bonica:

        Let's talk a little bit about leadership. What would you say is your leadership philosophy?

Vicenzi:

        I've done a lot more leadership reading in the past four or five years than I ever did before. I [inaudible 01:18:38] really? This is what ... I think my philosophy is servant leadership. I mean, we all have egos, we all have an ego, but I just never consider myself egotistical enough to know it all, or to know everything, like a lot of leaders come on. My view is that my role here is to facilitate the managers and the leaders that I have working for me, and to provide them, help them to achieve the goals that they set for themselves, and that we set jointly for the organization. I'm an advisor, I'm an advisor, and I know I have to make the tough calls occasionally, because that's where my responsibilities are, but I never feel like I'm the only one who ... I'm the one who knows it. I mean, I know it all. I view myself as a servant to my direct reports, to my employees, and to my customers.

Bonica:

        What are the characteristics and behaviors of a good leader and how do you aspire to those yourself?

Vicenzi:

        Good leaders talk the talk, and then they walk it. They exemplify it. They demonstrate what they talk. I believe, I don't know if I do that all the time, but I really try to do that all the time. That's my goal. I mean, if I'm asking ... I had a discussion, I go "Really, we have to be" ... I always thought ... We've got to be the bigger ... It's like be the bigger person and take the first step and take the initiative? I says "We got to be the bigger person here and take the initiative with that customer." It's up to do that first, and we should take the initiative. Don't wait for them to call you. "Oh, they were supposed to get back to me on that and they haven't." I go "Well, great, they were." I mean, actually, when we left that meeting, that was the idea, but take a step first. Step out there, be the first person to take the lead, I mean, you never know.

Bonica:

        How did you come to believe that these were the key aspects of leadership? Who do you think you've learned leadership most from? Whose examples do you keep in mind when you're reflecting on leadership questions? Who do you reach back to in your mind?

Vicenzi:

        I kind of ask me who my heroes are. Who are my heroes in life? You know, I don't really have a solid answer for that.

Bonica:

        Okay.

Vicenzi:

        I really don't. I really don't. I mean, when I look at people, when I look at examples, I look at organizations like Southwest Airlines and that guy Herb Kelly who ran that organization for a year or so, I think he's gone, now, but that kind of culture that they created there, which was one of service, and having fun. I mean, this is not bad. I mean, your employees were important and the service, I mean, I think that those are the kind of people that when I look at those kind of people in the marketplace, those are the kind of people that are the parallels to what I want to be. Those are the kind of people I want to try to be like or I want our organization to be like.

Bonica:

        Okay, what do you look for when you're hiring leaders, and evaluating leaders?

Vicenzi:

        Certainly, depending on what we're looking for, the technical, and expertise that we're looking for, but I'd say 50% of it, or even 60% of it is attitude and leadership and communication skills and ability to interact with people. I think it's a fine balance. I mean, I'm not saying that having somebody that's under-qualified by 60%, because that's all I want. I mean, I think the balance is all in a leadership role, is almost more tilted towards the communication soft, and the emotional intelligence kind of skills, than to the technical skills.

Bonica:

        You mentioned organizational culture a second ago, you referenced to Southwest. What is organization culture and why is it important, and how do you shape organizational culture?

Vicenzi:

        I hate to use hackney terms, but I always say that culture trumps strategy all the time. I mean, strategy is cheap, really. Look at the latest books, on corporate strategy and customer [inaudible 01:23:31], you can get that. Creating a culture where people want to come, you know, look forward to coming to work and look forward to providing the end product or the end service to your customers, and having customers who really have an appreciation for what you do, respect you and want to partner with you, that's really what it's all about. I mean, I think that customer/employee relationship and the employee/employer relationship are the keys to providing a great ... You really need to think about those two things, and you need to work at them. It's not as simple as "Take this step, take that step, take the next step." There's a lot involved in that emotional ... This is emotional intelligence, this is emotional intelligence in both of those dimensions that builds to the right culture that you want to have.

Bonica:

        You mentioned some folks who you considered to be mentors earlier in your career. How did they influence your thinking about leadership and about your career?

Vicenzi:

        That's interestingly ... I probably wasn't really thinking about leadership. When I think back to the people who, early on I said to you, "Jeez, these people saw more in me than I saw in myself." When they saw capabilities and abilities and valued my opinions. I kind of do a leadership by "I don't want to do that. I don't want to be like that. I don't want to be like that. I know that's not good."

Bonica:

        You've seen negative examples?

Vicenzi:

        I've seen negative examples of what leadership is not, and shouldn't be.

Bonica:

        Okay.

Vicenzi:

        I don't know if I hold on someone as the paragon of like "That's the leader I want to be." I know what I don't want to be.

Bonica:

        Aside from leadership in particular, how did these mentors help you develop your career, or move forward in your career early on?

Vicenzi:

        I think, in many cases, they gave me confidence in my abilities.

Bonica:

        Is that what a good mentor does, is give confidence?

Vicenzi:

        Yeah, well, they give you confidence. Well, actually, a good mentor can help you develop your abilities, also, or identifies how ... One of my best mentoring stories, and I don't have very many, really, I don't, is my executive assistant who is extremely smart. She's a very intelligent woman and very people-adept. Has very good people school, never went to school, never got a degree, but had some kind of a ... Well, by nature of her role, she would do benefit enrollments and HR-related work, and so I said "Sam," I go "Have you ever thought about going back to college, getting an education?" "Ah, school's not for me, I don't want to go back to school." I go "Well, you know, there is a lot of programs for people who've been in the working world that go back to school, and get certificates."

        That was one of her goals for the year, or a couple, I don't know, seven or eight years ago. We'd go look into ... She goes back and she goes "Hey, you know, I identified this thing here." I go "So, well, what do you think?" I said "Ah, I'm willing to give it a try." You know, the first class she comes back from, the first time, she goes "Oh my God." She goes "All those people in that classroom are just like me." You know? She went through and she got her PHR certificate, from USM, and what was that? I don't know what that was, it was more than a year, it was a year and a half kind of stuff, and then she kind of sat and got her certification as a certified professional human resources very soon thereafter, and she probably will be sitting for the SPHR exam at some point in the future, and she's just worked into that. She's my HR administrator now. I mean, that's the bottom line.

        She's worked into her role, and not only is she good, I don't know if she could be the HR strategist for an organization with a thousand people, given where she is right now, she does an excellent job, and I've had her do employee mediation of employee situations with managers and employees and stuff like that. The people come back to me and go "Thank God Debbie was there, man, she really helped us." You know? She's just really good at that. You know?

Bonica:

        So you identified this?

Vicenzi:

        I identified it, and I was really pleased that I did. I mean, it was a mentoring of need. Built out of need.

Bonica:

        Okay.

Vicenzi:

        I needed this mentor because I really needed somebody to step into that role and she was ready to do it. She does a great job of it. She's done a really great job of it.

Bonica:

        How do you develop leaders in your organization and what are your expectations for mentorship within the organizations? You've got leaders working for you?

Vicenzi:

        Yeah.

Bonica:

        What are your expectations of mentorship from them, to their people?

Vicenzi:

        In the past three or four years, we've attempted to do a better job of helping each of our directors level, manager, [inaudible 01:29:17] people understand their leadership styles, who they are, how they do, why they get done what they get done, what are their ... You know, we've done 360 evaluations to try to give them some insight. I can say that, as a corporate organization, corporately, we don't do a very good job of that. We just don't. It's like one of those things that I know we need to spend more time on, but it's like we don't find enough time to do the time on it that we need to spend on. Each of my directors have a sudden loss leader that they've identified that ... Do I remember the last time I sat down with my director and said "Where are you in the plan to make sure that that" ... I mean, and one area I know that the person is up to speed.

Bonica:

        Sudden loss leader, you mean if one-

Vicenzi:

        Something happens to my director-

Bonica:

        And they're out.

Vicenzi:

        Somebody then, would ensue the responsibilities on a day-to-day basis, until we determine who is going to fill that role.

Bonica:

        [inaudible 01:30:18] okay.

Vicenzi:

        In the case of this individual, what we've really done real well ... I comes down to the individual. A lot of times the individual director, the original manager, and none of them is equally adept at doing those kinds of things. It's just not. Overall, corporate organizational development, I guess you would call it organizational development is not where I would like it to be, and not where it needs to be if we're going to be a 500-employee organization. You know what I mean? We really need to ... We need to focus more attention on those areas. It would really be great ... We're on a very thin organization with not a lot of ... I mean, it would be great if I had extra HR staff support to kind of take initiative like that, you know, and develop the programmatic stuff so that we can have each of our directors and managers run through these kind of things. I know, it would be great for them to do, but it's like ...

Bonica:

        Most organizations don't have formal mentoring programs.

Vicenzi:

        They don't, and really, I mean, some of the good ones, if you read about them, they really do a real good job of that. Organizations that have been real successful. Then again, you're talking about organizations that get scaled. GE is really ... General Electric is notorious for being able to really build their managers, so they create managerial talent.

Bonica:

        Right, you're talking about tens of thousands of employees.

Vicenzi:

        And leadership. Yeah, I know and leadership training and skills and all that stuff. I mean, yeah, you're talking about that, we try to leverage off everything we can do, and we're generally ... Usually try to bring every other management team meeting, every other month, just to try to bring something to the table that's of relevance to leadership. A couple months ago, we had a really good program on personal resiliency and what that means and how that really impacts you on a day-to-day basis, and your employees. I mean, we try to do things like that. It's not as organized as I'd like it to be.

Bonica:

        Okay, fair enough.

Vicenzi:

        It's not as organized as I'd like it to be.

Bonica:

        When did you get involved in ACHE, you mentioned a couple of other professional organizations that you've been involved with over the years.

Vicenzi:

        Yeah, ACHE, I get involved in in the early nineties. When I was at the Greater Cleveland Hospital Association.

Bonica:

        You're the past president for Northern New England?

Vicenzi:

        Yes, and I've got a role with ACHE because when I started working back at GCHA, actually, I think I may have gotten involved earlier than that. I may have had my membership before I went to GCHA, but, I followed the development path when I got to GCHA and got my CHE.

Bonica:

        Right, right.

Vicenzi:

        Certified healthcare executive, took the exam early on, and I guess when I got the GCHA, if I were ... I started looking around and realizing that a lot of the professional peers and people that I was going to be working with, a lot of them were fellows at the college. I said "You know, jeez, I should be part of that organization, and I think it demonstrates to them that I have the same level of professional credibility that they have or the same level of professional interest that I did." I got involved then, and then, to that, came here, and got involved.

        Another thing, I was very active with the local chapter in Northeast Ohio.

Bonica:

        How did it help your career? Why would it be important for young people to consider doing it?

Vicenzi:

        I think it helped my career, but provided me a network of fellow colleagues and contracts that I could always call on. Either for [inaudible 01:34:21] call people and go "Do you know this person?" I'm talking to this individual, do you know them? You know? What can you tell me? You know what I'm saying? It's just the professional network of people. Has it personally taken my career in a different direction? I can't say it has.

Bonica:

        Has it enhanced it?

Vicenzi:

        Enhanced it, that's what I meant. It's enhanced it.

Bonica:

        It hasn't changed it, per se.

Vicenzi:

        It's enhanced it, and because it's broadened my base of who I know, and from a selfish perspective, it's opened up numerous doors for us, from a business perspective.

Bonica:

        Your customers as well.

Vicenzi:

        That I might not have been able to open as easily if I didn't have the collegial relationship that I had established through ACHA. I always tell people ... You know, people coming to the table for these organizations for a whole host of different reasons. Mine was somewhat driven by selfishness. You know? My ability to make contact with the right people I need to make contact with at the right time, and thinking that this will be a great avenue to do that. Interestingly, I had, what do you want to call it? A come to Jesus moment, when I was [inaudible 01:35:37] ... I went to Chicago for the installment ceremony, at the college, and they got them all gowned up, walked down with our gowns, and I go "Oh my God, Jerry, this is the level of professional competence and certification that you've reached, but you're sitting on the stage with the CEO of this institution in California or the CEO of this institution in Texas, and you know, you're one of them." I really felt really, really good about it.

        I've told people that again, numerous times, when you get your fellowship, go sit for the installation biz, it will give you a feeling of accomplishment and satisfaction and understanding. That's what it did for me, that I never really had before. It's really, really great. It was a great experience.

Bonica:

        Last question: what advice do you have for young people just starting a career in healthcare and healthcare administration? What should they be doing to be successful, what should they be reading? Who should they be talking to?

Vicenzi:

        If you're just starting out in this world, in this world of work today where things have changed so dramatically, you really need to be prepared to tell your story and talk to anybody and everybody who might potentially help you. I mean, I can only tell them that networking on the broadest possible basis, whether it's personal friends, colleagues, professional colleagues, people that your parents know, you really need to get out there and tell them who you are and what you want to do. Because the more you talk to people, the more ideas get generated.

        I don't think there is ... There is not a magic bullet anymore. I don't think it's as easy. I think it's more difficult than [inaudible 01:37:40] because you have so many qualified, very qualified, very intelligent, very well-educated competition that's out there in the marketplace, because the generation that came before me, and my generation said "We're going to send all our kids to colleges and they all need an education." Which, I think is great, but, the number of opportunities out there are limited and you need to distinguish yourself. I think you distinguish yourself through personal interaction with peers, both other peers or individuals who are in a position to potentially refer you or influence you or hire you. I think that's where you need to be, you need to be at the forefront. You know? I mean, I'm not a tech-savvy person, and so I don't think you could carry a campaign to find a job out on the internet, maybe you can, or on Facebook. I think, that's the ... My advice is you really got to work at it, and it takes time.

Bonica:

        Thank you so much for your time today, appreciate all the great information you shared.

Vicenzi:

        I hope it will be useful to you folks and it will be of value to some, one ... If it's of value to one of your students, then it will be of value, I guess, right?

Bonica:

        Yes, thank you so much.