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Becker Private Equity & Business Podcast
Jeff Freedman on CEO Leadership, Culture, and Long Term Success 12-17-25
00:34:31
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- [00:00]
A
This is Scott Becker with the Becker Business in the Becker Private Equity podcast. Each day we bring you one to two episodes with market and business insights. And then each day we try and bring you an interview with a business leader, someone who's extraordinary. Today I'm thrilled to visit with Jeff Friedman. Jeff has had this incredible career as a leader at the intersection of health care and private equity. He has led several different companies through operation, organization and exit, and has had a remarkable, remarkable career. We're going to talk to Jeff about leadership, about health care, about private equity, and a lot more today. Jeff, can you take a moment and tell the audience a little bit about yourself and your background?
- [00:47]
B
Absolutely, Scott. And first, let me just say thanks again for giving me a chance to talk about me a little bit. And really what I'm thinking about, it's. It's truly a thrill and an honor. I think I could probably take the entire podcast and talk about my career because I've had a lot of, you know, turn left, turn right, turn left, turn right moments. But I'll, I'll try and do it briefly by, by telling you that I started in the wine business, which we probably could spend some time talking about, but I spent 10 years, very formative years, working for the Gala Winery. I think it's relevant here because when you come out of college and you are not very formalized in business acumen, I got a tremendous education at Gallo. It culminated with me teaching management and sales classes, which, as you probably know, you never know a topic until you have to teach it. But I spent 10 years at Gallo and I launched from Gallo into the healthcare industry. You might say, well, that's an OD transition, and frankly, I thought it was. But I went to work for a very large dental manufacturer. And the connecting point was this idea of distribution. At Gallo, there was a three tier distribution system. You have a winery, you've got a distributor, and then you've got an end user, which is a grocery store or a restaurant. Same thing in dental, believe it or not, dental manufacturer, distributor, and using the dentist. And I really launched a career in healthcare that has spanned, I guess, something like 30 years. And my stops along the way, I think, have given me a more unique, well, rounded view of the healthcare ecosystem. So I mentioned I did a stop at a large dental distributor. I then decided that technology was the better angle to take. And I went to work for HBOC, which was being bought by McKesson at the time. I did that for a short period of time. And then I think, like everybody else. In the mid-90s, I had a stop@a.com. we had a bunch of money and we decided that we had the answer to the EMR crisis in the dental business. Unfortunately, we were ahead of the curve, but it was a tremendous experience on how to take private funding. Bessemer Partners was our, our primary source of private equity money at the time. And we learned what it's like to be under scrutiny of an investor. That experience was tremendous and frankly, it launched me into one of the best stops I had, which was at Manus Health Systems. Manus Health Systems was again, a little bit ahead of the curve. One of the first DSOs, sort of DSO before DSO was cool. And I joined a local company in Chicago funded by some friends and family. And really the concept was the basic playbook of the dental business, which is buy some practices, try and improve operation, roll them up, and ultimately transact that experience really was a stair step for me. I started in a key operations role and ultimately ended up leading the company. That company, interestingly enough, is the foundational piece of a shore capital business now. Great Lakes Dental. I ended up leaving the dental business because I had a calling to go into oncology. Again. I'm giving this look of sort of left, right turn. And when I moved into oncology, I went from being the president of a company to essentially carrying a bag. And what I mean by that is I was doing M and A deals. I really became direct physician, facing convincing somebody to join the US Oncology network, which was a big lift for people that had run their oncology practice independently for years. But it gave me an opportunity to really begin this very deep look at practice operations. I did that for a while, ultimately led the BD team for US Oncology and the acquisitions, and then moved into an SVP role for operations. And that essentially is the ownership of the P and L. When you own a P and L in the oncology business, you recognize that it's a huge ecosystem that is largely driven by drug distribution and drug costs. So the intimacy I had with how those interactions work and how the economics work really made a big difference in how I view healthcare in general. So I spend time in the oncology business and I do something that probably many of my peers said, what are you doing? I went to work for a payer. As we probably know, there are some positives and negatives about going to work for a payer. But because I had oncology experience, I really felt like I could make a difference on the payer side. And I went to Work leading a prior authorization division of one of the large national payers. You know, most would say, were you crazy? I will tell you, I thought I could make a difference. And if I look back and I feel bold about what I've done, I think there was a difference to be made. We really focused in the prior auth business around the clinical care versus the economics of should you use this drug or should you not? You know, what's the least expensive? It wasn't that at all. It was really more about what can we do to help physicians stay current with clinical pathways and how can we use that to help them get their drugs and their treatments prior authorized. So spending time on a payer is a great experience. I highly encourage it for everybody. But it wasn't the last stop for me. And I looked back at my career and said it was time to go back into operations and lead an organization. At that point I went and became the CEO of Akita Partners, which was an ophthalmology platform in the Chicagoland area. We were funded by a lower middle market private equity firm and it really was the get your hands dirty, roll your sleeves up type of role. We were merging practices, building a pipeline, trying to provide great access, thinking about culture, doing all the things that a CEO does in an organization that's a little bit on the smaller side. You tend to as the CEO, you know, deal with the physician compensation model at 9:00am, fix the printer at 11:00am, go to a board meeting at 4:00am and then listen to an employee at 7:00pm so look, there's a lot to be done in these organizations and when you're the CEO, you have to have your hands on a lot of them. So fortunate enough to be on the receiving end of a call from a very large ophthalmology platform owned by Shore Capital again and we ended up exiting in 2021, 2022, excuse me, post Covid and I had a time at that point to step back and ask myself what I wanted to do. I had spent a lot of years in operations, I had spent a lot of years in the sales ranks. I think I had a better than average understanding of healthcare, having been on the payer and done BD work and I looked at a bunch of options. Ultimately I landed with a terrific company, Modernizing Medicine, which is a emr, PM and patient engagement company. Not new to the space, dominant in several specialties. But what they needed was somebody to really bridge the gap between private equity, those big companies or small medium sized companies that were being bought by sponsors and essentially be a liaison between what the sponsor was thinking and what the large practice was thinking. So it's been a terrific opportunity to use my experience. I spend a lot of my days speaking with CEOs and in some cases sharing stories, in some cases being supportive, in some cases being a sounding board. Ultimately it's been this sort of culmination of, like I said, 30 plus years in healthcare. So that's a mouthful. It's the left and the right. But hopefully that gives you a sense of who I am and essentially what I've done.
- [09:56]
A
No, Jeff, it's truly a remarkable career. I wanted to spend a few moments talking about leadership and CEOs and cultures. Let me start with a couple questions there and thank you for the background. What have you learned about leadership that you might not have fully appreciated earlier in your career? Any thoughts there?
- [10:20]
B
Yeah, well, let me start with the obvious and that is I'm constantly learning what I know. Yesterday I probably didn't know a week ago. But I think more specifically to your question, I think there's probably a couple things that come to mind. I think the first one is there really isn't any room for ego. Not the bold statement. And I know some might say, well, you've got to have the confidence and you've got to, you've got to carry yourself with executive presence. I think those things are right. But ego really gets in the way of how you make decisions, how you build a team, how you project your behaviors to the people around you. And so the first comment I'd make is I've really learned that ego is not a positive word. The second thing about culture and sort of building something is we all wish it was an easy fix. Send out a mission, vision, value statement and maybe mention it on an all hands call and watch people get in line. Look, the reality is that's not how it works, works. This has to be part of your everyday message. I think the most simple component of culture is it has to be regular. And I think the third thing as I sort of step back and view my sort of leadership hat on culture and sort of building components of culture is things really do start at the ground level and that's how you build, you know, it's a house, it's, it's foundational pieces. If you aren't in touch, you and your management team with the people that are the everyday interacting with people with, with patients, if you're not talking to them and understanding what they're saying to Mrs. Jones when she comes in, I Think you tend to miss the opportunity to really build something. So I'm a roll up your sleeves, hands on guy that spends a lot of time with the people that are interacting with patients, the non clinical people. And I think that's how you drive messages. I just mentioned that. That's your behavior that gets modeled. Those are the things that people see when you actually are meeting them face to face, looking them in the eye and trying to understand what they do. So that's been a journey and it's been one that I've enjoyed and I think it's not for everybody, but it's certainly how my DNA is wired.
- [13:11]
A
But I think your point is so well taken on taking ego out of the equation as much as possible. And you always strike me every time I talk to you as having tremendous humility. And then also you have to actually be with people and talk with people. You can't just put it up on a whiteboard. You've actually got to do it and be with people and see and observe and help and be part of it. I couldn't agree with that more. Take a moment on when things aren't going well and you're CEO, what are the first things that you look for and how do you then respond?
- [13:47]
B
Yeah. So, you know, I think this is another opportunity to say there isn't a perfect answer here. I think each scenario probably dictates a little bit more. There's some specifics around a certain scenario, but I think by and large, I've often said to my teams there are always two sides of every story. You know, in healthcare we play a little bit of therapist when we have a staff and people want you as a leader or CEO to be the referee. Dr. Smith isn't getting along real great with Pat and Pat has a problem with Tammy. And these are the emotions that get in the way. And for me, I always view this as what's the two sides of the story? I think when we are trending away from what we'd like to do, I think it's super critical to slow down. I think there's a tendency for a lot of us to see a problem, say I know the answer, and then try and put something in place that is theoretically a fix. I think slowing down and being present for people that really understand the problem makes an enormous difference. I tell you, the other piece of this is if you've done the right thing around cultivating your team, around hiring the right talent, you tend to be able to step back and allow somebody else to fix the Challenge. I think you're looking at directional messages that are often data related, sometimes not. And you're trying to get at a sense of does the team have that problem understood? Sometimes you know, you're above it and so you can see it from a different lens. Sometimes you've got people that have a much deeper and more intimate understanding of what the issues are. And when you have that right team around you, there's a little bit of gamifying problem solving. We got this issue, how do we fix it? I think when you empower the right teams because you've hired the right people to make those decisions, it really becomes less of a task and more of a, yeah, we're going to face this problem. That's the kind of thing that happens in health care. And I will tell you, I, I've been hit with a lot of them, but every time I think I've been hit with all of them, I hear of another one that I, that I wasn't aware of. So, you know, you got to be a student of this game. You got to be constantly staying current and learning and hopefully you've got the right team around you to make a difference.
- [16:49]
A
I think that's so true. And it really is about building great teams and supporting great teams. Take a moment on the traits that you value most in senior leaders and what are those traits and, and how do you assess that someone's truly ready to lead a team, lead an area, lead an effort? How do you think about that?
- [17:10]
B
Yeah, let me give you a quick stat just to, to sort of frame this for a second. From 1970 to today, I think there's been something like a 200% increase in the number of physicians. That makes sense. You know, we have more physicians graduating even though there's a massive shortage. But there have been more physicians from that same period. So 1970 to today, there has been a, get this 3800% increase in the number of administrators. So what we're saying essentially is that there's a 10 to 1 ratio between physicians and administrators. So let me bring this back into your question about what the traits are. We clearly have this labor addiction, if you will. We seize the problem and we say, there's two things I'm going to do. I'm either going to hire somebody or I'm going to buy a new piece of technology. When I think about those traits that I'm looking for is I'm looking for somebody that really is resourceful in the world that we are immersed in. Healthcare wise. You have to be able to do more than one thing at one time. And I think that that's a, that's a critical component and it's not that hard to get to. Scott, you ask some questions about what you think a busy day is. Someone tells me that they have a meeting at 10 and they've got a recap at 4 and they've got a meeting at 6. Okay, that doesn't sound like a huge day to me. Let me know what happens in between those things. So I think assessing your ability to, you know, that old, that old analogy of the sticks spinning the plates, you know, you're on stage and one plate falls and then you've got to go to another plate, I think that ability is paramount. I think the second thing, and look, we could go through a laundry list of qualities, but the second thing is this idea of how quickly can you connect. Healthcare is a business of very quick and short interactions. If you're out of practice. And I think your ability to connect has got to be very skilled. You've got to do it quickly, you've got to be disarming. You're looking for somebody who likely as a patient is coming to a practice and probably anxious. You're looking to be calming, soothing, and really giving a sense of support. So if I look at the best leaders I've had, I look at those that have been compassionate, they can connect quickly and man, they are resourceful. They can get a lot done effectively in a day or an hour where somebody might be struggling because they've got too much on their plate. And I think those things in the world we live in today probably would have changed that stat a little bit. You know, I don't know, it'd be 10 to 1. It might be, might be 8 to 1, but I certainly look at this as, as an opportunity for us to get better.
- [20:14]
A
But the point is so well taken that there's still this huge value in people that have the ability to efficiently and effectively get a lot done and deal with a lot of people and connect quickly and make things happen. And you know, as an old adage, you want something done, you give it to a busy person. And at the end of the day, being a CEO remains a high energy job and being a leader is a high energy job. You know, even if that energy goes into hiring and connecting with the best people, the best team leaders still is ultimately a high energy job that takes a lot of energy and a lot of ability to get things done. Talking about this combination of strategy versus day to day Operational demands. How do you balance longer term strategy and thinking about the long term versus all of the daily connects, the daily operational things that have to get done. And how do you discipline yourself to keep focused on the long run while you're also taking care of all the short term things that have to get done?
- [21:15]
B
Yeah, that's such a pertinent question for frankly any leader and certainly in the CEO role. Let me start by telling you I blew it in that area a couple times at least. And let me explain what I'm saying here. I think one of the most challenging things of being a CEO was prioritization. You're basically describing that in the question. I've got this day to day fire that I've got to put out. I've got an IT issue or I've got something with a physician and yet I really have to think about growth. So when I think about those things, I start with the idea of being binocular, which means on one eye I'm looking at strategy, and one eye I'm looking at tactics. Said differently, you have to do both. There isn't really the opportunity to be only focused on the tactical operating metrics that you have or only focus on the strategy. I think you have to go into the environment, the game saying, I'm going to do both. The next part of that, I think for me when I've learned from my mistakes, is really carving out the right people for each one of those work streams, those teams. Think about your operating metrics, your tactics, that day to day stuff. There's a person that owns that, that you have to be intimate with, constantly talking to and really understanding what they're focused on. So I used to walk around practices and I would say to people, so what's the most important thing for you today? And when you ask that question, you get a very interesting mix of answers. If that operator, if that person that is chartered with the, the daily tactics, I just delivered that message, you're going to get a whole gamut of answers. But when they have a very strong message and people are all on the same page, you know, you ask 10 people sort of what's the most important thing today and you'll get 9 out of the 10 giving the same answer. That's a, that's a great piece. So I'm going back to the question by saying, let's segment the daily operations with a team of people that are focused on that. The strategy side I think is really critical to have a team devoted to that. But you are the leader of that, by all means. And what I'll posit is that strategies change. These are things that are moving and living organisms that get dictated by market conditions, by the financial climate that you're in, by events that you can't predict. And so for me, having that sort of segmented work stream of strategy, which I know going in, is likely to move a little bit. I'm not suggesting it changes weekly, but I think it has to be fluid, and you've got to be so current on what's happening in the market that you're willing to adjust a little bit. So I think the short answer, if I can condense what I'm saying, is it's critical to segment these and ensure lastly that the operations drive the strategy. You are really trying to every day, make sure that what you're asking people to do is driving ultimately where you want to be long term.
- [24:52]
A
I think the point is so well taken that it's got to be both. It's got to be strategy and operations, and hopefully they're well connected and complimenting each other. But I think it's so well taken. I love the concept of the binocular. We got to be on both. Both the strategy and the operations. Jeff, let me ask you two more questions. I'll start with this one. And I love something you said earlier on in the introduction about the best way to learn is to teach. I just love that. I just want to put a footnote on that, but what's a leadership mistake that you may have made earlier in your career that ultimately made you better at what you do, better as a leader, better as a CEO?
- [25:33]
B
Yeah, you say a mistake. I've certainly made a lot of them. You know, I. I probably will circle back here to something I said earlier and hopefully give you an example. I've learned that, you know, when ego gets in the way, and it sounds great to be at the 19th hole saying, I'm a CEO, you've really lost sight of the purpose. And so I have made that mistake when I tried to be all things to all people, because I know I'm the guy, I'm the person that has all this experience. I think it's really important to step back and understand what you don't know. And I think early on in my career, as I'm rising the ranks of leadership, and I did a little bit of a reflection for myself when I, when I was preparing for this. I've had 71 bosses in the course of my career in health care, and that's people coming in and out. And I've had 32 positions of leadership in the course of, you know, in and out of various organizations. And I think many of those early on I went in saying, I know how to do this job, I've got the most experience, I'm the, the most skilled at delivering on these goals. And I think confidence is great. I'm a big fan of it. But I think understanding what you don't know and being willing to ask and to surround yourself with a network of people maybe out of your company that will provide for you guidance. There's a message around having a board of directors. You know, the good ones are there to guide. The good ones have experience and they have a view on the challenges you're facing that may be different than yours. And so I always found that leaning on my board and really having that close connection with them made for a much more satisfying and fulfilling day to day life versus, you know, waking up at three in the morning and saying, God, I don't know the answer to that, or I don't have that figured out. I think those are things that really the more time you spend on the water in these roles, the more you realize it's really about the things you don't know. And it's okay to admit those to people that maybe I don't have all the answers, but I sure am interested in helping fix it with somebody else's guidance.
- [28:12]
A
Thank you. And Jeff, let me ask you one last question. For aspiring leaders, current or aspiring leaders, what habits or disciplines most consistently can help lead to long term success?
- [28:26]
B
Yeah, let me just thank you for this question because I'll start by saying, you know, I'm not Steve Jobs. I'm not giving a graduation speech at Stanford saying, you know, love your job and it doesn't become work. I don't know if I have that kind of creativity, but I really find myself where I am today in my career answering this question in a very pragmatic way. I think it's three things. I think the first one is, and I'm going to cling to sort of a little bit of a catchphrase here, but the first one is say it now. And this is a movement that you may be familiar with. I think the germination is Peter Attia and this guy Walter Green. I listen to this podcast often and it's a podcast about gratitude. And I think it comes from this idea that when people pass away and you go to their funeral and you have a bunch of people stand up, talk about how great the person was and how much impact they had. And isn't it a shame that, that those people aren't hearing that? And so my advice is, say it now. Become a part of that person's sphere and communicate how much you appreciate them. I. I don't know anybody that I've ever worked with that doesn't like to be appreciated, doesn't matter what level. And so I would, I would, I would suggest that begin with saying it now. I think the second piece of advice I would give is this idea of starting now. So, look, we all know that I didn't get to certain things yesterday, or I was going to do that last week. But if you mindlessly scroll through Instagram these days, you're seeing a lot of little snippets around procrastination. And how do you avoid procrastination? I think it's an easy one because we all procrastinate. But the answer is, start now. What am I going to do today? It's never too late. I think this personal beating up of, oh my gosh, I didn't get to that is really a challenge. And I think if you go into a situation and say, I'm not going to get to everything, but it's never too late to start, I think you'll find that you'll have much, much, much more fulfillment. I mean, Mel Robbins is somebody who espouses this. And I went to see Mel with my daughter, who's 22, in Chicago, and she really started the whole thing by saying, what are you going to do today? And I think it really frames the second point, the third one I would say, and this is really interesting as you think about the world we're in, and that is stay current. It's easy. You and I were in business when cell phones didn't exist. Okay. You know, we had a little carousel with pink messages that said so and so called, you have to today stay current. And it's moving fast. This isn't just understand what ChatGPT does, but use it, play with it, make it a part of your life. I think these are the things that, you know, you're reminded about when you interact with your children. But if you have the opportunity to stay current, what you'll find is that your ability to engage, your ability to make a difference in the project you have is dramatically enhanced. It also allows you to engage in conversations where you can admit, I don't know how to do that, or that's not something I'm familiar with. But staying current is an everyday project and I think there's a great value in that. So hopefully that is added to folks that are listening.
- [32:24]
A
I love all that. Let me ask you about two things. First, I love so much what Mel Robbins says and does. I love this concept of let them. And I find that concept useful almost every single day of my life in dealing with different business, personal, professional relationships. This concept of they're going to be who they are and you almost have to take that person as they are. So how did you, did you love with your daughter seeing Mel Robbins?
- [32:53]
B
Yeah, you know, I, we're not on video, but you might almost see me welling up here and you know, I throw her out and that, that experience and that either resonates for some folks or it doesn't. It was fabulous. And I had read the book and what I think is important when you see somebody like that or you sort of follow somebody is taking what they're saying and put it into your daily life. And so, you know, we all care about what people think of us. I mean, it's crazy to think that, oh, I don't care what they think or I can put that aside. No, we all care. Let's be fair, we're humans. But I think understanding that you can't really debate that or move that, the ointment that soothes that rash a little bit. And I think she's so practical about how you interact with people and what types of emotions get developed from.
- [33:55]
A
Being.
- [33:56]
B
Comfortable with somebody else's opinion. I thought it was fabulous. I mean, it was a sold out show. I had no idea. And I, you know, you walked out of there with a notebook full of notes on how you're going to take on tomorrow. So. Yeah, it was, it was powerful, I won't kid you.
- [34:13]
A
I just love that. Jeff, I want to thank you for joining us today on the Becker Business, the Becker Private Equity podcast. What a great pleasure to visit with you today. Thank you so much for joining us.
- [34:26]
B
Absolutely an honor. Scott, thanks so much for having me.