Episode 30: Scale Your Infusion Practice with Joshua Smith, Pure Infusion

Transcript: Position your infusion practice for scalability with Joshua Smith

Dylan McCabe: Welcome to the WeInfuse podcast. My name is Dylan McCabe and in every episode, we give you a behind the scenes look at the infusion center as we interview owners and CEOs of infusion centers and industry experts so that you can get tips, tools, and a roadmap to take your own infusion center or practice to the next level. I’m really excited about this interview because we interviewed Joshua Smith. He’s the Chief Revenue Officer of Pure Infusion. He’s got a lot of experience in this industry and he’s going to go really deep on some powerful principles regarding valuation how you value your business, he’s going to talk about major models the buy versus the build model, the key insights you want to look at if you want to go into a market and build an infusion center, all the things to consider there. And then he’s going to discuss scalability, how to scale that business, and set it up for an eventual purchase one day, we’re going to get into all that and much more in this interview. Before we jump into that if you don’t already have WeInfuse in your practice or your infusion center you owe it to yourself to learn about how WeInfuse can save you time and money. Just head over to www.weinfuse.com. You can schedule a short discovery call with one of our account executives or you can jump right into a demo of the software. You will be blown away by how it makes your life easier and enables you to grow a successful practice as well. Alright, as I stated, we have a special guest on the show today, Joshua Smith with Pure Infusion. Joshua thanks for being on the show.

Joshua Smith: Thanks for having me, Dylan. I appreciate it.

Dylan McCabe: Yeah, I’m looking forward to this because you have a unique background. You’ve been in the VC space, you’ve been in the mergers and acquisition space, and you’re the Chief Revenue Officer for Pure. So I’m looking forward to you shining a little bit of a different light on the infusion space and bringing some expertise there. But before we get into all that, just for our listeners, kind of share your background in the industry and how you came to Pure.

Joshua Smith: Yeah so I’ve been in the infusion business since 2013. And prior to that, I was in capital markets for 8 years, so I’ve done a lot of evaluating companies, not just healthcare companies, not just infusion companies, but evaluating all the types of companies that are out there. But in 2013, I got involved with just a strategic business initiative, it was a dialysis company that started an infusion business kind of as a side business; they had a lot of interest there and did a lot of great work. We did some partnerships with some practices and grow into some new markets across the country. And then I joined Pure in February of this year, and it has just been just a wonderful place to work. They’re a company that’s been around for just about 2 years, currently in three states in Colorado and Idaho and Montana, but really, really hyper growth-oriented, and looking to do some great work in the communities that they serve both today and tomorrow. So a great team of folks there and it’s been an interesting 7 years in infusion going all the way back to what we would consider being the heydays of Remicade, all the way up to today and biosimilars, bioidenticals, and in-office sub-queues and those expansions, and then some additional formularies that have come out, so it’s been just a wild ride, and I’ve really enjoyed it.

Dylan McCabe: That’s really neat. Yeah, you have such an interesting story. And, and I got to deal a lot with Trey, in the sales process with WeInfuse, but he clearly is on top of his stuff and a go-getter. I remember communicating with him and interacting and I shoot him an email man he gets back to me so fast. And I thought this is so great because this guy’s leading this company, and he’s being hyper-responsive and super detail-oriented. And I know you guys are experiencing some great growth. Well, now that you are with Pure and knowing the background that you have, let’s talk about valuation. When you have a skill set in that area, what are some principles of valuation that people should consider when they look into maybe partnering in an infusion center and investing in an infusion center or starting one? How do you go in with all the analysis you need?

Joshua Smith: Well, I think the first place from a valuation perspective you need to understand is the market that you’re trying to serve. As you come out of the gate there are some markets in this country that are very competitive from an infusion offering perspective. But being competitive doesn’t just mean one thing. It could be that there are a lot of infusion management companies that are providing a great service for the physicians in that area. It could be just tons of in-office physician practices doing infusion and taking care of their patients. It could be that there are infusion organizations, like many of them that are out there that are just diluted into the market, and they’re in every other block similar to dialysis centers, right. And then you’ve got some markets where the hospital systems have figured out with their sister models where they’ve got all these little community health, hospital locations, and they’re providing infusions in those locations. And then the last one is there’s a major pharmacy player that’s getting into the infusion space and doing a lot of work where they’re transitioning to home infusion, whether they’re trying to put them in a Walgreens or put them in anything like that. So all of those different mixes present different opportunities and in the individual market and so if you’re thinking about valuation, one of the first things that are going to come up is as well is what is going to be your patient acquisition strategy? Is it a partnership strategy? It’s what is most commonly called, what we call, a de-novo in the healthcare kind of VC space and that is just a clinic that you build from the ground up. And you don’t have a partnership with another healthcare entity, physician practice or pay your self-insured employer and you’re just going to go out and compete to provide service and price out in the market, right. And so that patient acquisition strategy is going to be very, very important because it’s going to speak to the stickiness of the revenue that you’re able to generate in that business, and that stickiness is going to be really important if you’re if you’re a company or a practice that’s looking to say, “Hey, I want to build this up, and then I want to potentially exit and I want to sell this to someone”. Well, one of the things that they’re going to look at is obviously, all the trends and the numbers and what you’ve done in the last 12 months, in the last three years, and are you levered correctly, but they’re also going to look at how sticky this patient population is if we come in, and we provide X, Y, and Z. Can we turn this patient population into a patient population plus x, or y, or z? Or margin. Can we expand the margin? And so I think the patient acquisition piece is one where they usually just assume well, here are our numbers, here’s where they come in. That’s it. But if you’re going into building an infusion offering, whether it’s in your office, as a physician, whether it’s an infusion management company, whether it’s, it’s one of the other models that are out there, you need to understand where you’re going to get those patients and what those patients mean, on the exit side of the transaction as well.

Dylan McCabe: And so when we were talking about this offline, you’d mentioned the buy versus the build model, can you kind of break those down a little more for people listening? Who is maybe looking at both in one versus the other?

Joshua Smith: Yeah, I think I think a lot of your in-office physician infusion is what we would consider being the build model. And that and that just means what they’re going to start self-referring or not self-referring, but they’re going to just open a room and start providing infusions to their patients, right. And in some of the other models, it’s really you open a clinic down the corner, maybe across the street from the health center, you staff it, and then you start to market it out to all the physician practices and all the other healthcare entities and out market, and you’re just looking to beat people on pricing service and be competitive in that space. So that’s the build model. The buy model is really what we call just a strategic partnership. So are you going to go into a market? And are you going to partner with someone who can do both? And there’s no doubt you should do both every time because there are so many patients right now in the need of a site of care, but the buying model is, is maybe you’re going to align yourself with a specific payer, maybe you’re in align yourself with a self-insured employer, and you’re going to provide at a lower cost and a better service then for their employees. Maybe you’re going to align yourself with a practice or a series of practices. What you’re doing is you’re going in and you’re setting up a strategic partnership with someone who is bringing to you some aspect of that patient acquisition. So you’re going to compete on the build side, you’re going to go out and get patient acquisition because you’re going to market and you’re going to compete on price and service just generally out in the space. And then you’re also going to maybe overlay that with strategic partnerships where there’s some sharing on the margin or the EBIT that’s created in the business potentially, or maybe you just got a great service contract to provide a much lower cost service and better care for a payer in a specific market. So if the infusion providers and the folks that are thinking about getting an infusion, they’re thinking about what is the best way to do that. In my experience and multiple companies, it’s a marriage of the buy and the build. You need to have marketing and sales in a build strategy to go get patients and to go get them from referring providers. But you also need to understand that in a lot of these markets, so much of this is moving, specifically in the world of COVID, that there are just tremendous opportunities to strategically align this practice or this business, this clinic with another entity who can actually get you to a larger swath of patients more quickly, as well.

Dylan McCabe: So if I hear you correctly, it’s really not buy versus build, if you want to go into this and be successful, it’s going into it and try to do both try and make strategic alliances that can enable you to scale and grow and to make sure you’ve really kind of diversified your services where you’re not dependent upon one source for like you said, patient acquisition. So with that said, when you guys look at this, and you expand, and you grow, and going back to valuation, what’s a big red flag that you would see, aside from market saturation in an area, what’s a big red flag that you would see, if you’re looking at an area and you think, “man, this is probably not going to be the best spot to open up shop”, other than saturation?

Joshua Smith: Well, depending upon what your model is, that’s really going to kind of dictate how you view a potential market. But one of the things that we’ve seen that can create a huge issue and a pull-through of the patient acquisition, and that is the lack of providers in a specific market. And so understanding that “hey, what if I wanted to go to X market”, right, and you say, well, in order to do that we’re going to be pulling patients in from pulmonology, and gastroenterology and rheumatology, neurology, and we’re going to go compete with all these different areas. But if you have a lack of providers in a particular specialty and one of the specialties that can refer large numbers of infusion or biologic patients or whatever. The issue you’re going to get there is your number of swings, the plate, your number of opportunities, are going to be much less. And the challenge is when those providers and we know that a number of the specialties, that are infusion writers have tremendous fall-offs and enrollment rates, particularly rheumatology. So understanding that in a market, you may go in and say we really like the payers, we like the reimbursement rates, we like the population basis. But if there aren’t enough physicians that are educated in that particular specialty, that is going to make your job really, really hard. Because what a lot of systems will do is they’ll gap that coverage with just general internal medicine, and so they’re not maybe a rheumatologist. So that’s one of the areas that I think is really important when you’re looking at the data. I think a lot of the infusion companies that are out there are looking at some of the regulatory changes that have happened in the space. And so I would caution and anyone in the industry, they’re all going to understand. So it’s called “site of care” restrictions, right? So you have, these are expensive medicines and one of the cost-saving measures a lot of the payers are enforcing. You’re saying, listen, you can do it in this site of care or this site up here, because they’re lower costs on the insurance plan, right? So a lot of companies and a lot of infusion companies are looking at the site of care and saying well if they’re deployed by the major insurance carriers, that’s the place I want to be. But the challenge is, like many times in business, it’s in the art more so than the science and the science is they have this policy, it’s there, I can see it, I can pull it up. But the art is, are they enforcing it? And are there markets within that state where they are enforcing it and other markets where they’re not enforcing it, because the infusion companies that are around whether it’s infusion management, infusion partnerships, infusion, we call them “novos”, just building infusion centers, or even specialty pharmacy, understanding that the enforcement of those regulations is really up to the payer. And so if you just build a business plan, it says, I’m going to go to this market, because they have sided care for all the commercial payers and that’s great for me. I’m going to pull them all out of the hospital or pull them all out. The challenge is they may or may not be enforcing it, and they may not have a plan. And it could take them multiple years for them to put together a plan, to start enforcing it, in that market. So when we talk about valuations, we talked about patient acquisition, sided care is one way to look at patient acquisition. It’s just you can’t place a lot of weight into it unless you’re really, really good at understanding and have really good intel and data on the enforcement of those policies. Make sense?

Dylan McCabe: Yeah, that’s good. And you’re dealing with these behemoth companies. So like, as you mentioned, if you have sided care optimization being implemented by one payer, it’s going to change by the market with the same payer or if you have site of care being implemented in a market, that’s going to change by the payer in that same market.

Joshua Smith: When we talk about the market, you could be looking at a very large market, and they’re enforcing it, or they’re not. And then you could probably look at a couple of hours drive west or south to almost a rural market, where they are, or they’re not in there, and they’re different within the same state, right. And so, just understanding those dynamics are going to be really, really important. Because the site of care optimization and that piece of the strategy is an important piece to understand, for an infusion company, whether it’s a physician who wants to do it, whether it’s an infusion management company wants to provide management services to any of the physicians in that market space, or if it’s a traditional infusion clinic company understanding that there may be opportunities to go get some patients, but those opportunities are going to be less sticky. And until you get in the market, many times, you’re not going to know the level of enforcement that the payers are enacting.

Dylan McCabe: That’s good stuff. So let’s kind of switch gears and let’s say you’ve done your valuation, you found that sweet spot, but between someplace that’s just totally oversaturated, versus being out in the boonies with no providers, you found a good place you’ve set up shop, you’re running your business, you’re working on site of care, optimization, and pay relationships and all these things. Some things that I think we don’t hear a lot about are the type of partnerships. That’s something you mentioned to me before we jumped on the show: the type of partnerships you’ve seen in this space, what are the different types of partnerships, and then we can get into the strengths and weaknesses of each one?

Joshua Smith: Sure. Well, I think different companies are looking for different strategic relationships. When we talk about partnerships I would use the term partnership loosely and just say what strategic relationship opportunities are there in a specific market, right. So a lender or a number of companies out there that are looking to partner up with physician practices, right. And the physician practices, physicians have been doing it for a long time. They understand that the challenge with physician practices is, as we all know, physicians are getting squeezed. They’ve been getting squeezed for a really long time. So this is nothing new. But with these expensive medications, there are some specialties where they have more medications that they could prescribe, other specialties where they have fewer medications they could prescribe. One of the challenges that you get with any of the partnerships is, and it doesn’t matter, and we’ll get into some of the others. But one of the biggest things that I see a gap in the industry right now is there is a true lack of both financial and clinical alignment. Most of the partnerships that I see out there, and these are good people, and they’re arranging quality partnerships on the outset. But one of the challenges that they’re running into is businesses can go up, businesses can go down. Volume census can go up, it can go down, profitability goes up and goes down. Over time, you can get skewed on the alignment of whether it’s the clinical offering. So if you’re partnering with a practice and you say well, we make the most money on this drug, but your partnership practice as well, but that’s fine. But I refer or I write, or I prescribe this drug over here, this drug over here and then struggle over here because I think they work better. And so you need to be very, very clear that you need to have clinical and financial alignment and strive for that over the long term. Because what that’s going to produce for you, is certainly a better alignment for evaluation upon an exit, by getting back to the different partnerships, so you have some infusion organizations that are out there. And one of their primary modes of patient acquisition is to partner with self-insured employers, right. And so that model is very streamlined. It’s very cost-efficient because you go in and you build a very small clinic, that’s either just adjacent to a right on the campus of an employer group, and they’ve got a certain number of lives that are working at the factory or working on their campus. And they just say, yeah what anybody on all of these really expensive medicines we’re going to send to you, and you’re going to charge us 50% compared to where they were going before, right. So you have some of those you have managed your organization, some of them are doing it in house, others are contracting it out. So there are opportunities for organizations to find some of those obviously, physician companies or physician entities are one that some groups look to partner with. Now, the challenge in partnering with a physician or a practice is you’ve got much more regulatory scrutiny. So if someone was looking to get an infusion and has a friend who’s a rheumatologist or a gastroenterologist, neurologist, and they just like I want to build this and partner up with him, you got to be really, really ready from a legal standpoint to make sure you’re setting up that partnership in a way that doesn’t get in the way of the physician’s ability to practice medicine, independently of the business. And so there are a number of regulatory things that a person getting into that business would need external counsel, to make sure that they’re setting it up appropriately the right way so that they don’t run a muck of anti-kickback, or stark, or corporate practice of medicine. There’s just, it just goes and goes and goes. There are certainly ways to do that. But it does take some more expense on the outset to do some of those things and there are other partnerships out there or relationships where you’ve got, payers and it could be a major payer in a particular market, it could be a smaller payer in a particular market. And they’ve got certain captivated lines, they’ve got these lines that they cover, and they cover all of the medical expenses per year for these patients. And their infusion treatments could be the most expensive aspect of that, right. So there are companies that are out, and they’re aligning themselves and contracting with those payers and saying, listen, we’ll place clinics out wherever your employees are, wherever these patients live so that they can get these treatments. And we’re going to set up a financial arrangement so that A we’re held to task on clinical quality initiatives and B, we’re going to set up a financial arrangement that’s lowering the cost of the delivery of that care to the payer in that market. And so then the payer then can set up that strategy. There are payers out there in this country that are, quite frankly, because some of these drugs are so expensive, they’re sending patients to Mexico for treatments. They’re paying for flights, they’re paying for hotels, for patients to go get their treatments in Mexico in some instances, which is sad. So I think that the infusion companies that are out there are expanding in some of these markets, I think they’re scratching an itch that the industry desperately needs.

Dylan McCabe: That’s good. We say this over and over again, but this is one of those business models where you need equal parts clinical expertise and business acumen because it’s a complicated model. You’re dealing with patients, obviously, the patient comes first and what’s best for them, but you have this issue of dealing with massive insurance companies and also very large top-line revenue. And if you make mistakes, the impact on your bottom line as a physician or somebody who owns an infusion center is dramatic. And you guys clearly know what you’re doing; you’re growing and scaling a successful company. But all this is so helpful, I say all that to say this is so helpful because anybody listening to this knows that this is not a simple undertaking here, there’s a lot to consider. There are regulatory issues there are just so many things to consider to do this. Well, and the thing that I’m getting out of a lot of what you’re saying is, man, make sure you are partnered with somebody who knows their stuff, and is very passionate about the patients but knows the business side of it.

Joshua Smith: I think that that’s exactly right. Anybody that’s going to that wants to get into the infusion space, whether it’s a, again, a physician practice, or a business person who knows, some people or whatever it might be even a pharmacist who does what I want to build my own fusion offering and my little market of the world. There are really good companies that have figured this out, there are also a handful of companies that are still working their way, through the challenges, and this niche of healthcare, as I call it, is a budding industry, but it’s still in its infancy and if you’re thinking, well, if I can grow this and go to a couple of markets, and drive some margin and drive some profitability, hey, I could get acquired, and that could be a nice little business. And that’s true. That’s true. But who’s, who’s going to buy it? Right? And is it if everyone is sitting around saying, well, it’s going to be one of the majors, that’s not necessarily true it may be a much more elegant and simplistic transaction to say I’m going to build this business around a particular payer footprint, because payers they’re owning everything in the healthcare supply chain they’re owning the providers all the way through the PBMS through the whole system, right. And so if you build a nice little business in your specific market, it doesn’t mean you need to cross state lines, you can do that, it just increases the regulatory scrutiny. And it changes some of the rules of the game, every time you go across the state line, the name of the game can be a little bit different, right. And so a lot of the companies that are out there today, I think, are doing a really good job, but they have gone through and taken their lumps. And I think that this industry is expanding right now, which is great. And if you were to ask most of your whether it’s infusion management, infusion providers, physicians in the space, there are plenty of patients to go around, it’s just expanding, at almost an exponential rate, the medications that are coming out. So the reality of it is a lot of us that are in this space believe that this space is here for the long term and is going to continue to look different every year. And some businesses have had more of a challenge with COVID than others. But that’s just the natural elements as things change in an industry. And this is something that none of us plan for. But some businesses were a little bit positioned for that just by luck. And some in some businesses had to do some pivoting. And they did very, very well. But I would absolutely agree with your statement that if someone is looking to get into the infusion business, whether it’s a physician, whether it’s somebody else, that they can source and find a quality business that can provide them some guidance in a system.

Dylan McCabe: Yeah, you better do your due diligence. Well, let’s shift gears and talk about something else. Because we’ve kind of got we’ve kind of gone through major phases of the business, from valuation and startup to partnerships, and the kind of strategy you have in place as far as partnerships and what you want to do to separate yourself in that market. Let’s talk about scalability. What do you do when you’ve hit cruising altitude and you really, you feel like you’ve got your processes down? You’ve got your core values; your vision is being realized you’ve got roles in the right place. You got the right seat on the bus as Gino Wickman would say in the book Traction. How do you scale? How do you get to where you need to be 5, 10 years from now?

Joshua Smith: Well, I think a lot of companies struggle with the scaling question and I think as it relates to infusion one of the things that in my previous life in some work I did when I was at. DaVita is obviously a perfect example of a company that started from the throes of bankruptcy and did some rebranding, committed to the employees, to the patients. It really was a culture shift and then they built this model, and then they were able to scale really, really well. And I think one of the things that all infusion companies have an issue with, and that is clinic level staffing is something that’s always a moving target. And the companies that are doing the best job from a scaling perspective, they’re not having to go find new employees every few months, because that is, that is one of the biggest drags on an organization is when you’ve got 15, 20 different open positions. And we also know that on a national basis, that staffing from a nursing standpoint, that there is a nursing shortage, just like some of the physician specialties that we talked about everybody’s looking to get being a nurse is a very competitive industry right now, specifically in if you’re in a highly-populated area. And so I think companies that are being very intentional about their career pathing, their messaging, their culture, and their internal marketing. So many of the companies they’ll say, you talk to a leader, and they’ll say, Well, my nurses have been with me forever. And that is, that’s a quality metric. But is that nurse necessarily good? That they may have been with you for 15 years, but if they come over to my business, they are going to be there for 15 minutes.

Dylan McCabe: They’ve been here 10 years, but they’re running everybody off.

Joshua Smith: That’s right, so the challenge is how does your internal marketing align with your culture and vision and values? What are you doing? Some market internally, to all of your clinic locations, as you said, you’re flying the plane, you got air cover, you’re in a couple of markets, you’re doing well, profitability is good growth targets, strategic alliances are coming out. And so you’re working on some great stuff, you can stub your toe as you’re growing, where you have to continue to look back and say, “man, we always have 20 to 30 positions that we’re trying to fill”. And so one of the challenges with scaling an organization is making sure that you have an appropriate internal marketing program that ties into your culture, vision, and values, so that people understand that, yes, this is the culture, is it a familiar culture? It’s a big company that wants a small company feel is what you hear all day long, right? But are you doing the right things, so that ever all of the employees from the frontline employees that are providing these treatments to the patients, to the administrative staff, that’s an all of it, you’re 12, 15 or 50, or 100, clinic locations, all the way up to your regional management, and then your national management, right, and it’s got to be something consistent. That aspect of scaling is something that I think is, at least, infusion hasn’t been as much of a priority. And quite frankly, it’s rightfully so because these companies are younger. And so they’re still getting to a place where putting together and having the financials to build an internal marketing strategy. You’ve got to get to a certain size, in order for that to make some sense. But even if you say you’re driving 5,10 million EBITDA, that’s a big enough size, where you should be spending time because every dollar that you spend there is much, much cheaper than the dollars you’re spending to go recruit and try to find an interview with new people. And most companies are not one person interview organizations. As you know, Dylan is there, you’ve got to meet with this person, you’ve got an interview with that person, maybe it’s a team interview. So you’re pulling in tons of bandwidth to do that. And, and again, we’re talking about scaling bandwidth is the name of the game. How are you parceling up the bandwidth on the key players in the organization so that you can continue to propel the organization forward? If they’re too busy looking back and trying to backfill bodies. They’re not looking forward.

Dylan McCabe: So good. So if I hear you correctly, it sounds like the chief revenue officer who’s a numbers guy and mergers and acquisitions guy before this is saying, scalability comes back to core values and vision and culture.

Joshua Smith: Mm-hmm. Well, when you’re thinking about the ability to scale to get to a certain size, that’s an area that’s often missed. Right? And you think about well is the model scalable? Usually, when you talk about scalability as well, our model is a joint venture with a physician practice, right? Okay. So how many practices can you get in front of, how quickly can you get in front of them and what is going to be your close rate? Again, most of those types of deals, Dylan, are a minimum 18-month process and infusion is a lifetime. But so many things change. So say we look at this and you have your 20 or 30 different data points, you look at to say, we’re going to build a clinic down on the corner of first and central, and then we’re going to go to market. Okay, how repeatable? That’s very repeatable, but it’s going to be some time before you’re going to see substantial or contribution EBITDA to the business. That would be interesting, right to a potential acquirer. If you’re an infusion management company, one of the challenges at some of the infusion management companies is was that clinical and financial alignment, they’re really good at getting the clinical alignment piece because they’re really taking a lot of burden off of the practice. But the second piece is the financial alignment you set up a contract to be a management organization on behalf of a physician. And you’re kind of at the whim of what are the contracts out there? Where’s the drug price going? What are the other formulations? You got a formulation, that’s an infusion that you get to capture the margin on and then all of a sudden, an oral comes out or they switch it to a self-injectable at home and so those are all external forces, that as an engagement company, you have less control the challenges as, as you march through time, how do you secure that long term financial arrangement? Do you have contracts where you have look back periods, and you can do true-ups, and you can do some things to make sure that as you continue to go back, and you’re scaling that business and bringing on new clients and new management clients, but you’re not getting churn, which is, you’re not getting old clients that say they we’re good we’re going to go a different direction right and so, each of the businesses have on a traditional scalability perspective they have different issues that they have to overcome.

Dylan McCabe: Yep. But it’s so neat that I just love that you said out of those issues with all those issues have to be knocked down, and you have to put processes in place. But I love that with your role and your background, you said, it comes back though, to vision and culture and relationships. Because nobody wants to work in a place that’s rocking and rolling financially, but you get anxiety just thinking about going to work because the culture is so bad, and it’s a caustic environment. So I just love that you took it back to that.

Joshua Smith: That goes to the patient, the patient sees that. And then you can spend $5 million on the nicest location in the world. But when it comes down to a patient, their experience with that nurse, and with those individuals and their relationships with those individuals in that clinic, are going to be much more of the deciding factor, whether they come back then the wallpaper, or the floor.

Dylan McCabe: Good. It’s good. It’s great advice. We did an interview with Gary Cooper, the executive chairman of Palmetto. And it’s so interesting because Palmetto is a great case study for how to have a successful infusion practice and model, but he took it all back to leadership and culture as well. So I just love that you guys champion that. And, because everybody needs to hear it over and over again, it’s easy to kind of get in the weeds and, and get too focused on not keeping the main thing, the main thing. And the main thing is the patient and the people, whether they work for you or they come to your center to get a very important drug that they’ve been prescribed.

Joshua Smith: And it’s difficult. It’s hard because whatever the infusion offering is for a company is there is a lot of competition. And there are a lot of opportunities, so a lot of leaders are focused on those and they need to be focused on those, but you’ve got to, you’ve got to lever your organization in the leaders in your organization, so that they have some of the soft skills to ensure that focus on the team, the culture, the leadership, the career pathing, everything that you want to do to keep good employees happy because good employees are going to treat patients good and patients are going to be happy. Right, and so it’s difficult and a lot of the infusion companies have scaled immunity and have grown pretty well, pretty quickly. I think the entire industry has quite frankly. So it’s not just one versus the other. I think everybody is enjoying the kind of mid growth phase. And the reality of it is if you are enjoying that, and you’re doing things, doing a lot of things the right way, don’t forget to take care of the people that are taking care of you.

Dylan McCabe: So good. Well, Joshua, we could talk about this stuff for another hour or two easy because I love the skill set you bring to it. And I’m learning a lot. And it’s just got me thinking about so many other things we could talk about, but for the sake of time, we’ll bring it to a close. So the last thing I’ll ask you is how can people get in touch with you?

Joshua Smith: People can get in touch with me through email, LinkedIn, obviously, cell phone calls. I’m very responsive. And anyway, I’m also involved with NICA. So if they come in through NICA, and they’re looking for some assistance there, I’m accessible through that I think there are a lot of people that are thinking about infusion, whether it’s a physician practice, whether it’s like a business person, or there are organizations out there that have been in infusion for a couple of years, and having kind of really figured out who they are yet and if they want some assistance there, obviously, I’m involved with Pure Infusion Suite. So if they reach out to Pure Infusion Suite, call and say you would like to talk to Josh Smith, they can do that. They reach out to me on my LinkedIn, they can do that, or they can do that through NICA. As I mentioned to you, when we were kind of talking offline kind of prepping for this call I see myself and I think a lot of the people that are involved in NICA as being kind of a servant of the industry, we’re doing whatever we can to raise the level of expertise across whether it’s the business side of the infusion, whether it’s a clinical offering side, whether its employees, leadership, management, all those different things. It’s really important that people know that there’s a community out there for them through NICA that they can access and get access to any type of not even it’s like consulting, but assistance in how they’re looking, how they’re building, how they’re growing. And in making sure that they’re going to be a quality provider long term in the space that they’re in. So and I appreciate you having me on.

Dylan McCabe: Absolutely. Well, Joshua Smith, Chief revenue officer with Pure infusion. Thanks for joining us.

Joshua Smith: Thanks, Dylan.

Dylan McCabe: All right, great interview with Joshua Smith. I love the fact that he has a background in mergers and acquisitions. And he also has a seasoned background in the infusion center world. But when asked about the most important advice he can offer, it comes down to culture and relationships. I just love that that shows you right there, that he’s a leader who knows how to properly influence people and how to build the kind of organization that people want to be a part of just wonderful stuff. Guys, if this has been helpful to you, please take a minute to rate and review on iTunes.