How finance leaders can think more strategically in medical practices

Health care finance teams are often buried in spreadsheets, but the ones driving real change are those thinking beyond the numbers. From challenging assumptions to reframing how data is tracked and presented, strategic thinking is becoming an essential discipline for finance professionals at every level of a medical practice.

Melinda Mastel, financial advisor at the Medical College of Wisconsin, sat down with Physicians Practice ahead of her session, "Spreadsheets to Strategy: Elevating Roles Through Strategic Thinking," at the MGMA Finance Conference in Phoenix, Arizona. She shares practical ways finance leaders can move past the day-to-day and start shaping bigger operational decisions.

The following transcript has been edited for clarity and length.

Physicians Practice: When someone brings you a budget problem, what's the first question you ask that gets you past the numbers and into what's really happening operationally?

Melinda Mastel: The first thing I look at is what's changed in the numbers. That gets you into context. Maybe someone's bringing you the problem, or maybe you're noticing it yourself, but breaking that down and seeing what changed helps reveal possible workflow changes or issues, as well as changes to data definitions that might be driving things. Whether it's operational definitions, workflow, staffing, volume, or documentation, asking what changed gets at all of those different pieces.

Physicians Practice: In your experience, what's the most common reason a medical group misses budget that has nothing to do with finances?

MM: In a way, it all connects back to finance, but the most common thing I would say is hidden operational shifts that go below the radar. It could be slight changes in how people's time is being spent, or how effort is being deployed that doesn't get officially approved or documented and isn't built into our financial assumptions or projections. It could be a change in workflow or a change in coding standards and rules. All of these little things just drift us away from where we expected to be, and they don't get captured.

Physicians Practice: What does strategic thinking actually look like for a finance leader on a normal Tuesday?

MM: Part of my presentation is really wanting to take this bigger concept of strategic thinking, which we all know is important, and make it something that's not just for executives or leaders, but for people at every level. And then also breaking it down, because it can come across as a little conceptual, into habits and questions we can ask. What does it actually look like to implement strategic thinking as a discipline? It can be alarmingly simple at its roots, but it's about getting in the habit of applying these questions to anything that comes across your desk. Do we agree on the actual problem we're solving? Who else is affected downstream? What decisions were made upstream that are coming to me? Do I know what precedents are out there? What is our scope? What decision are we in charge of making here? It's about making sure we're defining success, bringing the right people to the table, and asking good questions. That is really strategic thinking at its core.

Physicians Practice: You talk about moving from spreadsheets to strategy, which is a great turn of phrase. What's one moment where finance helped change a big decision just by reframing the story?

MM: The framing is so key. A simple example that was pretty impactful was looking at our basic accounting structure. We had a sub-specialty program that was growing. We were intentionally investing in it and recruiting for it, but we weren't tracking metrics separately. That program was being combined with a bunch of other programs in our data. We could manually filter it out, but any of the KPIs or metrics in our financial reports were not isolated for this program. It was really hard to tell what was noise and what was actually related to this specific specialty. So I recommended a change in how we were accounting for that to help isolate the data. When we're spotlighting those metrics and looking at dashboards and building the budget, just separating that out has been really impactful because we can track it separately and make better, more intentional decisions. Senior leaders are often just looking at those key metrics. They're not necessarily taking time to sift through all the background data. So thinking about how you're tracking, isolating, and presenting information can actually drive bigger operational changes than we sometimes expect.

Physicians Practice: When a leader is looking to launch something new on a tight budget, what blind spot shows up the most, and how do you fix it?

MM: When I heard this question, I thought about home renovation shows, where they often uncover things they weren't expecting and you see them building in a contingency factor. I think we just underestimate uncertainty and don't plan for unexpected circumstances. On the cost containment side, this means scaling down what you're trying to do. Sometimes we look at the ideal version and want to implement it right away, but one of the principles I'll be going over in the presentation is about starting on a smaller scale. That really comes from corporate innovation as a discipline: looking at what a minimum viable product is, looking at what a pilot would look like. Maybe it would be ideal to launch at 100%, but maybe we only have the budget to launch at 50% or 20%, and that's okay. What is a version we can do that's still testable, still gives us good feedback and results, helps us pivot and improve moving forward, helps prove value, and doesn't run out the whole budget? That leaves us some cushion for unexpected changes that can be out of our control.

On the revenue side, I also think it's about being creative with how we think about obtaining revenue. Coming from academic medicine, something I really enjoy is that we're not just doing patient care; there's also this research component and academic component. Looking at other funding sources, maybe it's sponsored funding or a grant, or some kind of project where you can study the impact of what you're implementing on health outcomes. Maybe it's partnering with another organization, leveraging the best of your strengths, and hedging risk a little. Maybe it's looking at philanthropic sources of revenue. Healthcare can feel constraining sometimes because there are limited levers we can pull, but I would say look at the cost side by building in contingency, starting small, leaving yourself room, and then get creative on the revenue side.

Physicians Practice: If you could give finance teams one project management tool they should start using Monday, what is it and why does it work in healthcare?

MM: There are so many different disciplines and frameworks in formal project management, but I actually think some of the real gems come more from the mindset and purpose behind those frameworks. Two of my favorite takeaways from project management are stakeholder management and getting clarity on scope.

Stakeholder management is so key. Make sure you're bringing the right perspectives to the table and at the right time, but not just relying on who you might typically invite into those conversations. Ensure end users are represented. Bring in people who might be from different functions but have useful skill sets, maybe they're great at bringing creative approaches, or they have strong detail-oriented process improvement backgrounds. Even if it's an operations person coming into a finance project, they can lend another angle. Make sure you're pulling in those people, getting feedback, and really driving value from people already on your team or in your network.

And then getting clarity on scope: What are we trying to solve? What are we tackling? What are we not tackling? Scope creep is so real, and it leads to projects that drift and lose their steam and motivation. We've probably all been on some kind of task force or committee where it started off really strong, and then we got pulled in a million directions and forgot why we were there in the first place. Establishing that scope and purpose up front is so important. Those are two really key tools from project management that may not strike people initially but are critical to keep in mind.

Physicians Practice: How do you get cross-functional teams aligned when everyone has a different definition of the problem and the urgency is really high?

MM: Something so important was said in the question here, which is different definitions of the problem. One of the key things I'll be speaking to is actually coming to a shared understanding of what the problem is. We can all see different facets of things, especially when we're working across functions, across levels, across practice settings, and there's a tendency to prioritize exactly what you're closely experiencing. But really zooming out and seeing the whole picture is so important, because often the pain points we're experiencing can be caused by some common root issues. Agreeing on what the problems are and coming to that shared definition is so important up front, because when we're making decisions downstream, coming back to that is what's going to speed up the process. Sometimes we need to slow down and take a little more time to document and establish what's actually going on and what we're trying to fix before we move to the next step. That can help avoid a lot of rework and extra time later on.

Physicians Practice: For someone who's early in their finance career, what's one skill that will most quickly turn them into a trusted advisor?

MM: I would say curiosity. There are so many good skills that I'll be covering, drawing from corporate innovation, change management, navigating the people side of things, communication, listening. All of these are important, and I think it's really important to build a multifaceted toolkit and make yourself a versatile professional. But curiosity is so key, especially early on in your career. Something I'm grateful for is that I asked a ton of questions. I gained a reputation for asking questions. If there was extra time at the end of a meeting, don't just leave. Ask for a different angle. Why are we making this decision? Who is bringing this up? Learn what's on someone's plate, understand the whole process, understand pressures outside of your own role, understand what pain points your manager is facing. That's what's going to set you up to not just be someone who takes work and executes it well, but someone who's really sought out for advice and recommendations, because you understand the big picture and you care about the causes behind things. It helps you function as a trusted thought partner, not just someone who's executing and analyzing work.

Physicians Practice: This is Physicians Practice, we're all about tips. What's one tip you would give a practice leader that they can implement today?

MM: Two came to mind, actually. The first is challenging assumptions. I'll be opening my presentation with that concept, because I think it's a really important mindset shift to be open to thinking outside the box. Healthcare can be really regulated and constrained. Depending on your practice environment and culture, there can be a lot of red tape, approval layers, and status quo thinking, things we just take for granted and assume need to function the way they're functioning. Rethinking that is so important. Some of those things may not be things we can realistically change, or it may be a slow change process, but sometimes there are things we can change, things we can have a discussion around, that we may not have initially thought we could.

Second, I would say expand who you're hearing from. Really think about what perspectives you're taking in and what parts of the organization they're seeing. We can all get in our own bubbles. We have our go-to people that we're working with most often. I would say anything you can do to expand that exposure, whether it's an open-door policy, starting office hours, or doing some rounds, just expand your perspective. Get to know the people on the front lines, get to know all of the different leaders in your organization, and avoid having the same voices in the same room all the time. That's something you can implement right away.