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Meet KRC: Our Fictional Case Study Firm

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How can your firm thrive through the ups and downs (and pandemics)?  Our Automating Success webinar series will take firms through every step of change, from business models and pricing to staffing to leveling up your advisory skills. 

As part of our Automating Success Masterclass series, we present you with this fictional story of a firm to highlight real-life challenges firms face in today’s world.  In each webinar, our thought leaders will share their expertise on how this firm might address those challenges and after each webinar, come back here to see what KRC has learned and what their action items are to take the next steps.  

Please note: this is a fictional story for entertainment and educational purposes only.   

Meet Klein, Rowe & Co. 

Firm Name :  Klein, Rowe & Co. 

2 partners (Martin and Martha) 

2 leaders on the team (1 is a Technical CPA and 1 is an Ops/Administrative person), 2 CPAs, 3 accountants/tax, 2 bookkeepers, and 1 part time support team. 1 Marketing Specialist in later years; 3 Contractors help on a part time basis for overflow work, and during tax season. One of the Contractors is Martin’s Mother.

KRC's Main Troubles

Klein, Rowe & Co is facing what might be familiar issues to many accounting firms, including:

• Business development, 
• Pricing for value,
• Redesigning their business model and roles,
• Team Structure,
• Value of Internal Financial Processes,
• Using/Deploying Strong Technology,
• Recovery during crisis,
• Focusing on Advisory

Meet our Firm Leaders

Martin and Martha both had a vision to start a different type of firm. They saw their value together in the last large firm they were in as they led the Consulting and Tax areas of the last firm, respectively. Though Martha was on the partner track, Martin became disillusioned as he saw a mismanaged firm struggle to consistently deliver value, remain distracted by poor technology choices, and a glut of new shiny services. As a result, they both saw the staff of that firm either leaving or remaining only to struggle in a poor culture. It was just a job.

Twelve years ago, Martin and Martha started Klein, Rowe & Co. because they knew they could do it better . They were even innovative enough to get a co-working space, start virtually, and run their firm on the cloud. Martin and Martha started out together in the co-working space and have remained in that model since the inception of the firm. They knew how to bring in clients, manage teams, and do the technical side of anything the clients would throw at them. They were ready to take over the world! 

The Early Years  

Since they were established professionals, new clients flocked to Martin and Martha because of their reputation at the last firm. Though the hours were hard at first, the work and clients poured in. It only took 6 months until they hired their first accountant virtually. Three months after that, they also hired a sharp virtual assistant that they were lucky enough to bring on full time within the next 6 months. After the first year, they had 1 virtual accounting/tax team member, their virtual assistant (who now worked in the cowork space with Martin and Martha), and a newly hired bookkeeper out of university. 

Martha is driven and spends a lot of time out of the office drumming up new business while Martin loves to solve the complex technical problems tucked away in his office. Martha was in charge of working with the consultant who created their website to manage the content and branding. Martha knew Martin had a knack for preparing for complex white collar crime cases they provided to local attorneys (and a few national law firms). Martin’s legal brief spreadsheets were legendary! So Martha went after the legal market and drummed up many law firms to begin serving their litigation practices. They took every client they could, so law firms weren’t their only focus. They worked with individuals, small businesses, and the odd client of 1 farm and 2 manufacturing companies as well. The work came in so fast, they had to hire a couple of people just to assist Martin. This additional team also prepared client tax returns Martin could no longer get to. Thankfully, they were able to hire some smart people (though these team members were expensive to pull from other firms). 

When it came to marketing their services, Martha handed over the website and any marketing efforts to their virtual assistant, but because work was coming in, they didn’t put much focus on it  At this stage, they had a website and used a free email marketing platform to occasionally send out a marketing email -- but there was no focus or strategy applied. They didn’t feel it was needed. Business was strong.

After all of the growth, hard work, and new team members, Martin and Martha were making good money with only a few years of focused business development and the money to hire smart people. 

The First Growth Ceiling

As is common with service based firms, when the team grows to between 7 to 10 team members, things get complicated fast. Martin and Martha were too busy to focus on stuff like processes, core values, and culture, so complaints started arising out of the first few team members. Further, though they have been committed to the cloud, they failed to implement a cohesive accounting Tech Stack that guided the onboarding and implementation of their services with clients and team.  Other than the occasionally-used email marketing system, they didn’t have a tech stack to help manage their own marketing and business development.

Team members thought they were ready for raises and promotions, but Martin and Martha weren’t in tune to things like that. Onboarding clients into piece-meal pieces of cloud technology stopped being successful, and was more of a responsive move (some of the technology they suggested to their clients, but they would also use anything the clients brought too). 

After 5 years, a couple of team members left that they had to replace with some quick hires due to the large legal forensic caseload Martin was always trying to manage. A common growth strategy is to “throw people at the problem” as firms grow quickly. This is what Martin and Martha did with no thought of how to onboard these team members, how to train them on their processes or uses of their strategic accounting technology, or how to help them specialize in Klein & Rowe’s legal advisory focus. 

Further, they were adding so many clients in all types of industries, and all types of broad services that they lost a few large clients and one significant law firm client. They also struggled to make payroll in one part of the year. This has never happened before and was troubling. After spending some time trying to figure out this cash shortage over a long weekend, Martin and Martha found that the administrative team member had not been billing a large law firm case (and never even took in the case’s large $12,000 retainer). They approached the team member on the phone that weekend (Martin was furious!) with the problem; the administrative team member never came back to work by sending a vague email about a new position they had found. They had to look to a temp hiring solution on that next Monday to keep all of the balls in the air.

Even with these first bumps, KRC was still a strong firm with consistent clients. The work wasn’t as fun as it had been for Martin and Martha but maybe this is what building a firm is supposed to feel like? After steady growth (with a few bumps along the way), 8 years showed about the same client base, but with some turnover happening regularly on the team now (but Martin and Martha never had time to think about the turnover). Things seemed to be getting out of hand. Martin would have said “this firm is driving us, not the other way around.” Martha didn’t want to talk about it - she just went and got more clients. 

Move Towards Advisory and Leadership

Martin and Martha have attended some interesting conferences and webinars and kept hearing how advisory and the cloud was the way of the future. They had been solidly doing both of those for some time. They had a thriving legal firm support niche and had always worked in the cloud, so they thought they were solid on those fronts. 

After these webinars and conferences, they were left scratching their heads as to why they felt their firm was running them if they had always seemingly focused on the right things?

Still, the work was getting overwhelming especially as they had to keep giving new team members work without sufficient training to do the work or use the technology well. They took a leap of faith and promoted their first team member to a position of leadership. This team member could almost out work Martin and had saved the firm many times on missing deadlines and technical mishaps over the years. They knew this was the right person for the first leadership role. They also put this seasoned team member as the lead with some large law firm clients. Martin was overwhelmed by the workload, so they thought this move to promote a new leader to the firm and put them in charge of some large clients would alleviate his work. 

Martin was mostly left in the firm to manage the firm and processes, while Martha thought of new ideas, new technology, new services, brought in just about any client that would pay, and continued to stay focused on business development. If there was a problem in the firm (team leaving, struggling with profitability, or failing to make payroll) Martha would either throw new revenue at it, or try to hire new people. 

She also decided to hire their first full time Marketing Specialist to help. In addition to marketing, the Specialist handled a lot of Martha’s business development administrative work including follow up on local events and new clients. Martha gave her random things to do, such as an occasional email blast, or a topic to write a blog post on, try a Facebook ad now and then, add a service or remove a team member from the website. 

There were many times that revenue and new team members showed up without Martin even realizing what was happening. Further, the new promoted leader created a few big mistakes on large clients, had fired one person from the firm without Martin and Martha’s permission, and was becoming more and more agitated with the remaining team. 

After 8 years, KRC was glutted, slow moving, had higher demands from more prominent clients, struggled to show profit, and had a culture that was becoming harder and harder to thrive in. Though the team turn over continued, they were able to promote another administrative team member that had been with them 3 years to the role of Operations Manager. No one really knew what that role was meant to do, but Martin and Martha were looking for relief. 

10 year anniversary

After the firm’s 10 year anniversary, the Operations Manager hired a part time support person on their own to relieve the overwhelming work the Ops Manager had (since they still stayed deeply involved in accounting and tax preparation). This part time person was not engaged, but did take some firm accounting and payroll off of the plate of the other accountants and the Operations Manager.

Klein, Rowe & Co. was stable, but struggling on a number of fronts.

Pandemic Troubles  

Martin and Martha didn’t realize it, but they were leading an unhealthy firm. Here are some of the problems they had been ‘investing in’ over a decade:

Glutted services, 

No discriminate client onboarding strategy, 

Claiming a narrow marketing niche (around law firms) yet taking every client they could,

No strategic pricing strategy that leverages their decades of wisdom,

No strategic marketing plan to help bring in consistent leads and new customers 

Chasing shiny technology instead of strategically deploying technology, 

Lack of team care and training,

No sticky culture that holds strong members to the firm, and attracts others,

No team or process structure to push their work through the firm, and

A complete misunderstanding of how to roll advisory into their firm. 

The KRC firm hit a major crisis with the onset of the COVID-19 global virus spread in early 2020, quickly followed by the government’s confusing, cloudy bail out of small businesses. To further the exasperation, and probably unintentionally, the government leaned squarely on the shoulders of accounting firms to navigate the confusing and added untold levels of work and stress on to already taxed firms.

U nhealthy firms struggle to survive or remain healthy during times of crisis. This became a scary reality for many firms during the pandemic. It’s difficult to turn around a sinking ship. Unhealthy firms become more unhealthy as they layer pandemic-related struggles into their firms and teams with quick, murky guidance coming from all over the profession.

Healthy firms are ones with cash in the bank, established processes, those that lead their firms and clients, using strong technology in their already designed firm processes, abilities to onboard their teams and clients into the firm’s process and Tech Stack, differentiating value and pricing in their marketing, as well as strong leadership that loves their team and cares about an engaging and challenging culture. 

This was not the situation of KRC, and they began to struggle in ways they couldn’t control anymore. Clients stopped buying certain services, more team left, forensic legal cases slowed to a crawl (thereby slowing retainers and billings). Their previous minimal marketing efforts meant that nothing was in place to help bring in new customers and their Marketing Specialist wasn’t experienced enough to know what to do to change it. Martin and Martha started missing some paychecks, they continued to ignore their technology and process woes, and failed to find suitable team replacements for the team that started to leave. 

What changes will KRC make? 

Follow our Automating Success webinar series to see how Martin and Martha can reimagine their firm to thrive in the future and then return right here to get their key takeaways and action items. 

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Bill Gates’s Leadership and Impact on Organization Case Study

Leadership style of bill gates, its key issues and underlying issues, the facts that affect these issues, tentative solution to the problem and its implementation, follow-up and contingency plans.

William Henry Gates, who is better known simply as Bill Gates, is one of the most well-known leaders today. Having co-founded the software corporation of Microsoft and served as its leader for a long period (USA Today, 2007), he led the enterprise to succeed in the global software market. In fact, over long years, Microsoft had been the monopolist in the computer software market, and it remains the largest software company in the world (Cohan, 2015). Therefore, it is paramount to discuss the style of Bill Gates’ leadership, as well as to consider its possible adverse aspects and issues which might hinder the progress of an organization.

It is stated that Bill Gates is one of the most successful leaders, or perhaps even the most successful leader nowadays (Cohan, 2015). It was, to a considerable degree, his efforts that led the corporation of Microsoft to its global success. Bill Gates himself was able to make a great profit thanks to this business and became one of the wealthiest persons on the planet (Cohan, 2015). Due to this major and long-lasting success, it might be possible to state that his leadership style proved to be most effective, and it may be likely that there are no crucial flaws in it. The style of Bill Gates includes such dimensions as focus and clarity of thought, the ability to “think big,” passion, life-long learning, and giving back to society, in particular via charity organizations (Krishnamurthy, 2008).

As for the leadership style of Bill Gates, it is stated that he was able to make successful business models (Microsoft monopolized the operating system market and stimulated hardware producers to collaborate with it), and think in the long term; also, he was always willing to analyze and doubt his ideas (Cohan, 2015). What is crucial is that Gates was able to hire and motivate talented and competent individuals to work for the company (Cohan, 2015). He employed the model of transformational leadership, which allowed Microsoft to adapt to several attacks from outside (SANS Institute, 2016).

Critics speak of several issues that are characteristic of the Gates’ leadership style. However, the key problem that played an important role in Microsoft is that intellectual criticism in many cases tended to turn into personal attacks (Cohan, 2015). This problem tended to significantly lower the motivation of the enterprise’s workers, as well as to drive away talented employees (Cohan, 2015). This problem grew out of the practice that was common in Microsoft – to challenge the ideas of one another, doubt them, and put them to the test (Cohan, 2015).

One of the main facts which affected the useful habit of doubting and challenging various ideas was the culture of aggressiveness, which was rather strong in Microsoft (Cohan, 2015). In this company, employees were encouraged to challenge the ideas of one another, which proved rather effective when it came to developing new software. However, this challenging often turned into personal aggression directed not only at ideas but also at people (Cohan, 2015). Therefore, under the influence of the organizational culture, the effective and useful practice turned into a detrimental habit which hampered the further progress of the company.

The habit of practicing personal aggression towards one’s co-workers or subordinates poses a significant problem, for it decreases the levels of motivation of workers and might even cause them to leave their workplace permanently. Thus, leaders should discourage such behaviors, instead of focusing on collaboration (Hughes, Ginnet, & Curphy, 2012). It is stated that “leadership must be based on goodwill… It means an obvious and wholehearted commitment to helping followers” (“Quotes on Leadership,” n.d., para. 14). Leaders should also set standards of behavior for other employees (“Human Relations,” n.d.). Therefore, the criticism of ideas should be common, but it should not become personal. To achieve this, it is paramount to encourage people to think over ideas and criticize them, while at the same time promoting mutual respect and collaboration (Kurucz, Colbert, & Wheeler, 2013).

To make the respect and collaboration the mutual traits of the employees of a business, it is critical to make these characteristics of behavior a part of the organizational culture of that company (Hughes et al., 2012). Therefore, the leaders of the organization should initiate this change; the managers should be instructed to behave accordingly. In case this method does not yield outcomes, the leaders and managers should continue stimulating employees to criticize ideas, stressing that if such criticism allowed for improving these ideas, the critics should be considered contributors as well; but the leaders need to directly discourage personal attacks (Cohan, 2015). The followers should be taught to view one another as business partners (Day, 2014).

Therefore, Bill Gates’ being the leader of Microsoft allowed the business to grow and become the largest software company in the world. The leadership style of Bill Gates might be labeled transformational (SANS Institute, 2016). His leadership, however, had several negative aspects; one of the most important ones is that the criticism of ideas tends to grow into personal criticism, decreasing employee motivation, and driving away talented workers. To address this, it is crucial to use managers to encourage the criticism of ideas without the criticism of people, promoting the view that employees should view each other as business partners and treat them with mutual respect. This should also become part of the organizational culture.

Cohan, P. (2015). 8 leadership insights from Bill Gates and Steve Ballmer . Web.

Day, D. V. (2014). The Oxford handbook of leadership and organizations . New York, NY: Oxford University Press.

Hughes, R., Ginnet, R., & Curphy, G. (2012). Leadership: Enhancing the lessons of experience (7th ed.). New York, NY: McGraw Hill.

Human relations . (n.d.). Web.

Krishnamurthy, B. V. (2008). Bill Gates: Entrepreneur, manager, and leader . Web.

Kurucz, E. C., Colbert, B. A., & Wheeler, D. (2013). Reconstructing value: leadership skills for a sustainable world . Toronto, Ontario: University of Toronto Press.

Quotes on leadership . (n.d.). Web.

SANS Institute. (2016). Bill Gates and trustworthy computing: A case study in transformational leadership . Web.

USA Today. (2007). Business leaders . Web.

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Home » Management Case Studies » Case Study on Entrepreneurship: Bill Gates

Case Study on Entrepreneurship: Bill Gates

Bill Gates was born in Seattle on October 28, 1955 to his parents, Mary and William Gates II.   He has two sisters. His father was a prominent Seattle lawyer, and his mother was a schoolteacher, University of Washington regent and chairwoman of United Way International. His great-grandfather was a state legislator and mayor, and his grandfather was the vice president of a national bank.

Bill strongly believes in hard work. He believes that if you are intelligent and know how to apply your intelligence, you can achieve anything. In school, he had an excellent record in mathematics and science. Still he was getting very bored in school and his parents knew it. Bill’s parents came to know their son’s intelligence and decided to enroll him in prestigious Lakeside private prep school, known for its intense academic environment. Bill first started working with computers at the school. His mother was on the committee that donated the terminal to the school, which was connected via a telephone to a local computer company. Bill and a few other students formed the Lakeside Programmers Group, and nearly spent all of their time on the computer writing programs for various purposes. The group was even banned from the computer for a few weeks for hacking into the security program and altering data on the system. Many of the group members ended up working at Microsoft as programmers. Bill later went onto Harvard University, but dropped out in 1974 to form Microsoft with Paul Allen, who had been a friend of Bill Gates since childhood. Bill Gates had known Steve Ballmer at Harvard, and they worked on programs together for the Altair computer.

Bill Gates and his close friend Allen started new company of their own, Tarf-O-Data. They developed a small computer to measure traffic flow. From this project they earned around $20,000. The era of Traf-O-Data came to an end when Gates left the college. In 1973, he left home for Harvard University. He took the standard freshman courses with the exception of signing up for one of Harvard’s toughest mathematics courses. He did well over there, but he couldn’t find it interesting too. He spent many long nights in front of the school’s computer and the next day asleep in class. After leaving school, he almost lost himself from the world of computers at the end of Bill’s first year. Allen came close to him so that they could follow some of their ideas. That summer they got job in Honeywell. Allen kept on pushing Bill for opening a new software company.

Within a year, in 1975, before graduation gates left Harvard to form Microsoft with his childhood friend Paul Allen. This pair planned to develop software for the newly emerging personal computer market. Bill Gate’s Microsoft became famous for their computer operating systems and killer business deals. For example, Bill Gate talked with IBM for letting Microsoft to retaining the licensing rights of MS-DOS and operating system that IBM needed for their personal computer. Gates then succeeded in making a fortune from the licensing of MS-DOS.

On November 10, 1983, in New York city, Microsoft corporation formally announced Microsoft windows, a next generation operating system.

Many criticize Gates not just for his success, but because they feel he tries to unfairly and maybe even illegally dominate the market. As a result of Microsoft’s market control, the U.S. Department of Justice brought an antitrust lawsuit against the company in 1998, saying the company had an illegal stronghold on the software industry.

Gates maintained Microsoft’s success over rivals such as Oracle and IBM was simply the result of smart, strategic decision making. U.S. District Judge Thomas P. Jackson did not agree, and in November 1999, he found Microsoft to be a monopoly that had an exclusive control that used its market power to harm competing companies . Because of the ruling, Gates faced the prospect of breaking up Microsoft.

On January 13, 2000, Gates handed off day to day management of Microsoft to friend and right hand man Steve Ballmer , adding chief executive officer to his existing title of president. Gates held on to his position as Chairman in the reshuffle and added the title of chief software architect.

Gate’s early experiences with computers included debugging (eliminating errors) from programs for the computer center corporation’s PDP-10, helping computerize electric power grids for the Bonneville Power Administration.

While working with the Computer Center’s PDP-10, Gates was responsible for what was probably the first computer virus, which is a program that copies itself into other programs and ruins data. Discovering that the machine was hooked up to a national network of computers called Cybernet. Gates invaded the network and installed a program on the main computer that sent itself to the rest of the network’s computers and cybernet crashed. When Gates was found out, he was severely punished, that caused him to stay away from computers for his entire junior year at Lakeside.

Gates and his friend Allen first wrote a BASIC interpreter for the Altair computer. BASIC being a simple and interactive computer language designed in the 1960s and ‘interpreter’ program that executes a source program by reading it one line at a time and performing operations immediately.

There were many other interests that Bill Gates had of which were encompassing medicine and the arts. In 1989 he started a company called Corbis. Corbis owns the rights to 800,000 digitized images. The images are licensed by newspapers and magazines and published by them either in print or electronic form. Another interest of his is biotechnology because of the breakthroughs that have occurred using this technology. He believes that with the internet, researchers will be able to communicate faster with each other. Finding the best way to treat or prevent illness is important to Gates. He donated $1.5 million in 1998 to the International Aids Vaccine Scientific blueprint project in the hope of developing a vaccine for Aids.

By the end of 1988, Gates was worth around $39 billion, making him the wealthiest man who is self made in the whole world. In 1997, Microsoft recorded a net income of $3.4 billion. This made up 41% of the profits of the 10 largest publicity traded software companies. Windows 98 and 95 were released in this time period and they got a huge response from the world.

Gate’s competitive drive and fierce desire to win have made him the most powerful force in the software industry. According to the record it took a lot of his personal life and in the six years between 1978 & 1984 he took a total of only two weeks vacation.

Microsoft’s vision is “A computer on every desk and Microsoft software on every computer”. Bill is a visionary person and works very hard to achieve his vision. His belief in high intelligence and hard work has put him where he is today. He does not believe in mere luck or God’s grace, but just hard work and competitiveness. Bill’s Microsoft is good competition for other software companies and he will continue to stomp out the competition until he dies. His beliefs are so powerful, which have helped him increase his wealth and his monopoly in the industry. He is quite giving person when it comes to computers, internet and any kind of funding. Some years back, he visited Chicago’s Einstein Elementary School and announced grants benefiting Chicago’s schools and museums where he donated a total of $110,000, a bunch of computers, and provided internet connectivity to number of schools. Secondly, Bill Gates donated 38 million dollars for the building of a computer institute at Stanford University. Gates plans to give away 95% of all his earnings when he is old and gray.

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Case Study of Bill

Bill is a married man with two grown children. He laments the loss of his parents, especially his father. Bill's father, who passed in his late 40s early 50s from a fatal illness, had a drinking problem; Bill has a propensity for the same. Bill's mother was critical and judgmental lending to Bill and his siblings having a discordant relationship.

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Enhanced right to ask for flexible working comes into force

Employees in England, Scotland and Wales can now request flexible working from first day in new job

Employees will have the legal right from Saturday to request flexible working from their first day in a new job.

Previously, it applied only when someone had worked for their employer for 26 weeks or more.

Peter Cheese, the chief executive of the Chartered Institute of Personnel and Development (CIPD), said the new right could benefit millions of workers.

He added: “Flexibility around time, scheduling and place of work can be transformative in opening up opportunities for people to get into and stay in work, especially those who have health conditions, caring responsibilities, or other life choices they want to make.

“With an ageing population, and rising levels of economically inactive people due to ill health, flexible working is more important than ever, and has been shown to support better wellbeing, making it good for individuals as well as organisations.

“The pandemic accelerated the understanding of flexible working, and the demand for it, and many organisations have responded positively by introducing more flexible working policies.”

The conciliation service Acas published a new statutory code of practice on requests for flexible working alongside guidance.

The Acas chief executive, Susan Clews, said: “There has been a global shift to flexible working following the pandemic, which has allowed more people to better balance their working lives, and employers have also benefited from being an attractive place to work.

“Our new code aims to foster flexible working further and covers the new law changes. It sets out good practice on flexible working requests and will help employers and employees avoid any pitfalls.

“There are many types of flexible working such as part-time working, flexitime, job sharing, staggered hours, hybrid and home working.

“The starting position for businesses should be to consider what may be possible.”

A study of 4,000 workers by campaign group Timewise found that half would consider asking for a flexible pattern of work using the day-one right to request in a new job.

The Timewise chief executive, Claire Campbell, said: “The new legislation will help job hunters feel entitled to ask about flexible working options and requests could start coming thick and fast.

“Flexible working and diversity and inclusion are interwoven, and businesses that make the most of the opportunity could really open some doors to new and exciting talent.”

Research by campaign group Pregnant Then Screwed found that mothers were twice as likely as fathers to ask for flexible working after parental leave.

Joeli Brearley, the chief executive of the group, said: “Mothers are more likely to shoulder the lion’s share of the unpaid labour required to care for children and manage a household. As a result, they are more likely to need flexible working. Just three in 10 job adverts offer flexibility, limiting the progression opportunities and earning potential of mothers.

“Then we wonder why the gender pay gap widens when couples have children and continues to widen further over the subsequent decades.”

• Employment law
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Ministers warn English councils not to adopt four-day working weeks

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‘We feel we’ve earned it’: UK over-50s on switching to part-time work

Burnt-out from work? Try following Hugh Jackman’s 85% rule

Britons least likely to say work is important to them, world study finds

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In Battle Over Health Care Costs, Private Equity Plays Both Sides

As medical practices owned by private equity firms fuel overbilling, a payment tool also backed by such investors helps insurers boost their profits.

By Chris Hamby

Insurance companies have long blamed private-equity-owned hospitals and physician groups for exorbitant billing that drives up health care costs. But a tool backed by private equity is helping insurers make billions of dollars and shift costs to patients.

The tool, Data iSight, is the premier offering of a cost-containment firm called MultiPlan that has attracted round after round of private equity investment since positioning itself as a central player in the lucrative medical payments field. Today Hellman & Friedman, the California-based private equity giant, and the Saudi Arabian government’s sovereign wealth fund are among the firm’s largest investors.

The evolution of Data iSight, which recommends how much of each medical bill should be paid, is an untold chapter in the story of private equity’s influence on American health care.

A New York Times investigation of insurers’ relationship with MultiPlan found that countering predatory billing is just one aspect of the collaboration. Low payments have burdened patients with unexpectedly large bills, slashed pay for doctors and other medical professionals and left employers that fund health plans with high, often unanticipated fees — all while making the country’s biggest health insurance companies a lot of money.

Often, when someone gets insurance through an employer and sees a doctor outside the plan’s network, the insurer routes the bill to MultiPlan to recommend an amount to pay. Both MultiPlan and the insurer receive processing fees from the employer, usually based on the size of the final payment: the smaller the payout, the bigger the fees.

This business model has made Data iSight a cash cow. Of the handful of tools MultiPlan offers insurers, Data iSight consistently makes the most frugal recommendations, typically resulting in the highest fees.

MultiPlan, which has been publicly traded since 2020, did not respond to detailed questions about Data iSight. A statement issued by an outside public relations firm said MultiPlan’s payment recommendations were fair and “widely accepted.” It said the company was “committed to lowering out-of-network costs,” including by using “data-driven tools to determine fair reimbursements.”

In recent years, concern over private equity’s investments in medical practices has grown, as studies have documented rising bills. Insurers and MultiPlan say that Data iSight is a necessary counterweight.

Caught between these moneyed interests are patients, who are mostly in the dark. If they encounter Data iSight’s name, it is typically in the fine print of dense paperwork. Those who have complained said they got little more than assurances that the calculations were rigorous and fair.

For Mary Lavigne, who has chronic pain, chiropractor appointments near Irvine, Calif., almost doubled in cost. Nadia Salim’s Boston-area therapy appointments also became almost twice as expensive. And Andrew Faehnle was on the hook for more than two-thirds of an ambulance bill after his 14-year-old was rushed to an emergency room in Anaheim, Calif. In each case, insurance statements cited Data iSight.

“I thought, ‘Who the heck are these people?’” Mr. Faehnle said. “I started Googling, ‘What’s Data iSight?’”

‘The Time Seemed Right’

MultiPlan’s business model is based on simple math: Take the amount a doctor charges, subtract MultiPlan’s recommended payout, and you have what the firm identifies as a savings or discount. Usually, MultiPlan and the insurer each collect a percentage of that declared savings as a processing fee.

This arrangement helps insurers profit from the most common way Americans get health coverage: through an employer that pays medical claims with its own money, using an insurer only as an administrator. Using MultiPlan, insurers cut medical bills, then charge employers for doing so.

For decades, MultiPlan determined payments primarily through negotiations. The discounts were modest but came with an agreement not to collect more from patients.

After MultiPlan’s founder, Donald Rubin, sold it in 2006, the company’s new private equity owners began a move toward automated pricing that executives would later call “MultiPlan 2.0.”

In 2010, it bought Viant, an Illinois-based firm that used algorithms to recommend reimbursements . But for some types of care, Viant’s calculations used a database of billed amounts. So if medical providers charged more over time, the recommended payments were also likely to rise.

A small firm in Grapevine, Texas, had developed an alternative strategy. Rather than start with a bill and negotiate it down, Tom Galas, a former insurance executive, wanted to calculate the cost of care and negotiate it up.

Mr. Galas bought an analytics firm called Data Advantage in 2005 and assigned a team at his company, National Care Network, to execute his vision. The result was Data iSight.

It drew on data that medical facilities submitted to the federal government and techniques developed by Medicare to estimate treatment costs. It then threw in some extra money, meant to allow a fair profit. The goal was to save insurers and employers money without paying so little that providers would sue them or go after patients for the balance.

In 2011, Mr. Galas sold to MultiPlan.

“The industry was condensing,” he said. “The time seemed right.”

Though he considered Data iSight revolutionary, he said, even he didn’t anticipate what it would become.

‘MultiPlan Is Magic’

Executives from the country’s major insurers gathered in Laguna Beach, Calif., in 2019 and heard from Dale White, a MultiPlan executive vice president.

He presented a slide showing the cover of a self-help book, “Life Is Magic,” that had been digitally altered to show Mr. White’s face and to read “MultiPlan Is Magic.” The slide added: “We have a few things up our sleeve, too.”

The firm’s annual revenues had reached about $1 billion, and three sets of private equity investors had cashed in. After buying MultiPlan for just over $3 billion in 2010 from the Carlyle Group, the firms BC Partners and Silver Lake sold it for a reported $4.4 billion in 2014 to Starr Investment Holdings and Partners Group, which sold it two years later to Hellman & Friedman for a reported $7.5 billion.

Hellman & Friedman, which owned the company when it went public in 2020, declined to comment.

Fueling the growth was Data iSight. The annual revenue it brought MultiPlan grew from $23 million in 2012 to more than $323 million in 2019, according to an investor presentation in 2020. The next year, the chief executive, Mark Tabak, told investors that Data iSight was MultiPlan’s top moneymaker among its biggest insurance customers.

While the company continued to offer other tools, it pitched Data iSight as an “industry-leading” and “state-of-the-art” way to “maximize savings.”

For insurers, the tool came with trade-offs: lower payments but potentially more patient complaints. They rolled it out gradually. The nation’s largest insurer by revenue, UnitedHealthcare, began using it in 2016 for certain plans and treatments, documents show.

As Data iSight spread, patients, doctors and medical facilities began receiving unwelcome surprises. Some practices that had negotiated contracts with MultiPlan found that they no longer received their agreed-upon rate, and patients were no longer protected from big bills.

Brett Lockhart had spine surgery at a facility near Cocoa, Fla., that had a negotiated rate with MultiPlan. When his insurer used Data iSight, he found himself on the hook for nearly $300,000. The bill is the subject of litigation and remains unpaid.

‘Crazy Low’ Payments

There was more to MultiPlan’s rising fortunes than just an increase in the number of claims. The average fee from each claim also grew, executives told investors.

In a presentation shortly before it became a publicly traded company in 2020, MultiPlan stressed that its tools were “scalable”: Reducing payments by just half a percent could yield an additional $10 million in profits, the company said.

After MultiPlan fell short of a revenue target in 2022, Mr. White, who had become chief executive, assured investors that the company had an “action plan” that included “aggressively implementing new initiatives with our customers to help them cope with accelerating health care costs.”

A change to Data iSight’s methodology, he said, should produce an additional $6 million in revenue.

MultiPlan has told investors it plans further “enhancements” to the tools, including use of artificial intelligence.

As patients and providers have demanded an explanation for declining payments, MultiPlan has fought to keep details about Data iSight confidential, contending in lawsuits that the information is proprietary.

Interviews and documents, some obtained after The Times petitioned federal courts, offer some insights .

Data iSight starts by using Medicare’s methods for setting rates. But subsequent calculations are less transparent. MultiPlan says it applies multipliers that allow for a fair profit for hospitals and something approximating a fair market rate for physicians. The documents show that MultiPlan allows insurers to cap prices and set what they consider fair profit margins for medical facilities.

MultiPlan has pitched Data iSight as an alternative to simply paying marked-up Medicare rates, an option some insurers offer. Paying around 120 percent of the government-set rate “sounds fair, maybe even generous,” one MultiPlan document said, but this is “inherently misleading” because “the average consumer does not understand just how low Medicare rates are.”

Interviews and documents, however, indicate that Data iSight’s recommended prices are sometimes about 160 to 260 percent of Medicare rates — amounts former MultiPlan employees described as “ridiculously low” and “crazy low.”

Even rates that may sound reasonable can strain medical practices. For example, UnitedHealthcare, citing Data iSight, offered Dr. Darius Kohan roughly 350 percent of the Medicare rate for a surgery to repair a patient’s eardrum. It amounted to $3,855.36.

Dr. Kohan, who has a small practice in Manhattan, said skimpy payments were forcing him to consider joining a large hospital system or private-equity-backed group.

“I am a dinosaur, but my patients like that,” he said. “I may not be able to sustain it.”

Chris Hamby is an investigative reporter for The Times, based in Washington. More about Chris Hamby

As vacation rentals eat up housing in South Florida, controlling them might become harder | Opinion

I n the fight over vacation rentals, it’s the property rights of rental owners versus the rights of neighbors whose lives are disrupted.

The Legislature this year settled the issue doing what it does best: preempting what cities and counties can do to regulate rentals and giving the state more power. In perhaps a recognition of how problematic their bill is, lawmakers carved out an exemption from some new requirements that only benefits Flagler County, where House Speaker Paul Renner, R-Palm Coast, lives.

The debate over vacation rentals isn’t only about rowdy party houses in quiet neighborhoods. It is also about the housing crisis in South Florida.

Vacation rentals alone certainly cannot be blamed for the lack of affordable housing, but studies suggest that they do contribute to the issue nationally, even if by small amounts. Properties taken off the market to become vacation homes may be decreasing the availability of long-term housing for Floridians, a 2023 Florida Atlantic University study found. A report by the New York City Comptroller found that, between 2009 and 2016, Airbnb contributed to 9.2% of the city’s overall rent increases and 20% in areas with a heavy concentration of listings.

Let’s look at Miami Beach as a case study.

There are 5,852 short-term rentals registered with the city, but the real number could be as high as 10,000, according to a city study.

The Beach had a total of 50,725 housing units in 2023, the vast majority of those condos, according to city data That means short-term rentals might represent anywhere from about 11% to 20% of Miami Beach homes, though it’s hard to tell if those estimated 10,000 rentals are an entire unit or just a room in someone’s home.

Is that enough to tighten the long-term housing market? The answer is not definitive, but there are other issues with vacation rentals, too.

In Fort Lauderdale, a shooting at a short-term rental killed a 20-year-old man last month, scaring neighbors in a residential area. Miami Beach cited the owners of an Alton Road house where another shooting was reported last year for running an unregistered vacation rental. Neighbors told News7 that late-night noise and cars blocking driveways were a constant at the address.

Commissioner Alex Fernandez told the Herald Editorial Board such rentals equate to commercial enterprises in residential areas that don’t have the infrastructure to deal with more traffic, visitors, garbage and noise.

Homeowners, of course, should have some leeway to make money off Airbnb or Vrbo. And local governments shouldn’t scapegoat short-term rentals for their failure to grow the supply of affordable housing. But those officials are the ones who directly respond to citizens when a vacation rental goes wrong. If Gov. Ron DeSantis signs Senate Bill 280 , there will be less they can do.

While it makes sense to have rules that are consistent across the state, too often that results in a one-size-fits-all regulation, impractical in densely populated urban areas like South Florida. More than 20 Republicans — including Sen. Ileana Garcia and Rep. Fabian Basabe, who represent Miami Beach — joined Democrats in opposing SB 280.

The bill creates state rules that property owners and advertising platforms must follow and eliminates regulations by local governments created after 2011 (Coral Gables is among the communities with pre-2011 rules).

Cities and counties would still be allowed to charge “reasonable” registration fees, fine property owners and suspend and revoke registrations. But municipalities and counties would be prohibited from setting occupancy limits with the state now dictating that. Up to two people would be allowed per bedroom, plus two in a common area, but more than two would be allowed per bedroom if there is at least 50 square feet per person. Miami Beach currently imposes a limit of two people per bedroom.

The bill also bans current Miami Beach rules that regulate advertising platforms and require owners to show what portions of a unit are being rented, permission from a condo association, proof of insurance and fire code compliance, Fernandez said.

These rules didn’t address the city’s housing affordability crisis — that remains a big issue — but if we can’t prevent vacation rentals from worsening the housing crisis, communities should at least be able to stop vacation rentals from becoming a nuisance.

Click here to send the letter.

©2024 Miami Herald. Visit miamiherald.com. Distributed by Tribune Content Agency, LLC.

Healthcare costs are scaring people, study says

(CNN) - Millennials and Generation Z are experiencing a new wave of anxiety when it comes to medical costs.

According to a new study , 67% of Gen Z and 62% of millennials avoid seeking healthcare because of the price, compared to 46% of Americans overall.

The study was commissioned by insurance firm, Assurance IQ.

A similar study done last year by the Federal Reserve found that a quarter of all Americans went without medical care in 2022 because of the price.

Copyright 2024 CNN Newsource. All rights reserved.

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