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Medical(Management(Innovations,(Inc.((

I.((Introduction!(

In!the!spring!of!2013,!Medical!Management!Innovations,!Inc.!CEO!and!Founder!Rich!Pflederer!is!reflecting!on!the!past!and!envisioning!the!future!of!his!company.!!He,!along!with!twentyEtwo!fellow!colleagues!are!working!to!create!and!maintain!high!levels!of!selfEmanaging!colleague!accountability!and!autonomy!while!delivering!solid!business!results!in!the!competitive!world!of!medical!case!management.!!!!As!he!envisions!the!future!of!MMI,!Rich’s!key!questions!are:!!•!Is!MMI!truly!selfEmanaged,!as!it!describes!itself?!If!not,!how!could!it!be!further!organized!to!become!selfEmanaged?!!•!What!methods!or!resources!could!help!further!MMI’s!selfEmanagement!with!most!of!the!workforce!working!from!home?!!•!How!do!you!keep!a!remote!workforce!connected!and!engaged?!!!•!In!what!ways!can!communication!among!remote!employees!be!made!to!function!at!a!higher!level!to!enable!more!effective!selfEmanagement?!!•!How!can!MMI!improve!employee!financial!understanding!(especially!regarding!cash!flows)!in!order!to!move!the!business!forward?!!Rich’s!company,!formed!in!1997!out!of!frustration!of!working!with!large,!bureaucratic!case!management!companies,!targeted!its!market!with!the!strategy!of!being!much!more!efficient!and!costEeffective!than!its!larger!competitors.1!!MMI!works!with!insurance!companies!who!write!workers!compensation!insurance!in!the!State!of!Illinois!(and!the!bordering!areas!of!nearby!states),!helping!them!manage!their!injured!worker!medical!claims,!and!facilitating!a!timely,!cost!effective!return!to!work.!!!!Other!MMI!services!include:!Limited!Assignments,!Scheduling!of!IMEs,!Scheduling!of!peer/record!reviews,!Telephonic!Case!Management,!Resource!for!physician!and!provider!information,!and!Catastrophic!Case!Management. MMI!has!nurses!scattered!throughout!the!State!of!Illinois!who!work!from!their!homes!and!travel!to!attend!doctor!appointments!with!injured!workers.!!There!is!one!office!that!seven!colleagues!work!from,!the!rest!work!from!home.!!MMI!colleagues!working!from!home,!to!a!large!degree,!must!necessarily!selfEmanage.!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!1!Medical!Management!Innovations,!Inc.!Employee!Handbook,!01/2010,!Rev.!6,!p.!7.!

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A!key!strategic!advantage!of!MMI!is!its!ability!to!meet!customer!needs!through!its!agility!and!flexibility—made!possible!by!its!small!size.!!As!articulated!on!the!website,!MMI!states!that:!!As#a#small#company,#we#can#tailor#our#services#to#meet#your#needs.#We#are#flexible#and#service#oriented.##We#perform#activities#based#on#what#will#move#your#file#toward#resolution.##Our#staff#is#thorough,#professional,#and#concise.##We#strive#to#make#your#job#easier#while#being#available,#cost#effective#and#efficient.!!MMI’s!Mission!Statement!is!published!on!the!home!page!of!their!website.!!It!reads!as!follows:!Medical#Management#Innovations,#Inc.#is#committed#to#meeting#our#customer’s#needs#through#our#expertise#by#being#accessible,#knowledgeable#and#flexible.##MMI’s!Vision!Statement!declares:!We#strive#for#personal#and#professional#development#so#we#provide#excellent#quality#of#service#to#all#customers#at#all#times.##MMI!was!founded!on!the!core!values!of:!!#• Integrity#- Do the right thing, walk the talk, take personal responsibility •#Partnership#- Being team players, honest feedback, win-win •#Responsibility#- Accountability, ownership •#Knowledgeable#- Ask questions, mentor/share experiences, provide alternatives • Resourcefulness#- Looking for new ideas and answers, share resources and ideas, using what is at hand As a self-managed company we filter our decisions first thru our core values and then look at honoring the three pillars of customer, employee and company equally. This is the foundation that our company is built on and functions on a daily basis. Self management requires communication and information sharing at all levels of the organization to give an understanding of how the company works.2 !MMI!is!now!structured!as!a!flat!organization,!with!a!Leadership!Team!for!overall!company!guidance.!!It!is!further!broken!up!into!regional!teams!for!nurse!case!managers!as!well!as!an!office!team!for!the!administrative!staff.!!Each!team!has!a!facilitator!that!rotates!between!team!members!so!that!each!team!member!fills!the!role!of!facilitator!on!a!rotational!basis.!!Also!each!nurse!case!management!team!has!a!representative!of!the!office!team!as!well!to!help!with!communication.!!There!is!also!a!facilitator#team!that!helps!bridge!the!gap!between!all!the!teams.!!All!current!facilitators!participate!in!a!phone!call!every!two!weeks!to!hear!about!what!is!happening!with!the!other!teams.!!MMI!articulated!selfEmanagement!principles!are!as!follows:!!As a self managed company we operate in a team environment that utilizes communication and information exchange. We are aware of what is needed to make a team effective and challenge one another to participate in continuous improvement.

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!2 #13.!Principles!of!SelfEManaging!Firms!(internal!MMI!document). !

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Our desired reality for our self managing teams is: #•#Honoring#the#three#pillars#of#customer,#employee#&#company#equally##•#Communication#and#information#sharing#within#and#among#MMI#Teams##•#Platform#to#allow#the#company#to#grow#and#be#healthy#for#all#parties#involved##•#Dashboard#to#check#the#pulse#of#the#team# •#Communicate#and#share#information#for#continuous#improvement##•#Challenge#one#another#to#participate#in#company#process#•#Be#aware#of#any#new#markets#or#services#•#Caring#for#team#members# •#Open#honest#communication#among#all#MMI#staff#•#We#are#all#in#this#together#making#improvements#as#we#learn.# We use the steps of collaborative process improvement as a tool to solve issues and problems as they arise. We know that change is a part of life and with the tools we have in place we do not fear change but embrace it, to make ourselves and our company better.3 The!ideas!of!quality,! teamwork!and!employee!satisfaction!are!further!evidenced!in!the! welcome! statement! in! the! MMI! Employee! Handbook: You have joined an organization that has established an outstanding reputation for quality. Credit for this goes to everyone in the organization. We hope you, too, will find satisfaction and take pride in your work here. As a member of Medical Management Innovations, Inc.'s team, you will be expected to contribute your talents and energies to further improve the environment and quality of the company.4 The! Handbook! also! provides! explicit!mutual! expectations! for! both! employees! and!MMI.5! ! The! concept! of! role! clarity! is!underscored!by! the!acronym!used! for!MMI! job!descriptions:!SOLAR,!which! stands!for!Statement!of!Limitations!and!Responsibilities.6 Rich!has!been!working!on!developing!selfEmanagement!for!some!several!years.!!In!October!2008!he!attended!a!Vistage!meeting!where!the!agenda!for!the!November!meeting!has!Lanny!Goodman!coming!to!talk!about!the!SelfEManaged!Company.!!As!Rich!says!in!his!own!words:!!!The!tag!line!about!the!meeting!made!me!interested!in!hearing!him!speak.!!“Do!you!own!your!company!or!does!it!own!you?”!!I!knew!I!didn’t!own!the!company!!!After!Lanny’s!presentation!in!November!2008!I!read!his!book,!the#end#of#management,!where!he!describes!his!selfEmanagement!ideas.!!Based!on!his!book!and!further!conversation!about!engaging!him!to!take!us!through!the!transition!we!start!in!January!2010!into!becoming!a!selfEmanaged!company.!!What!brought!us!to!this!point!started!in!2007!when!my!wife!and!realized!if!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!3!!#13.!Principles!of!SelfEManaging!Firms!(internal!MMI!document).!4!!Medical!Management!Innovations,!Inc.!Employee!Handbook,!01/2010,!Rev.!6.,!p.7.!5!!Medical!Management!Innovations,!Inc.!Employee!Handbook,!01/2010,!Rev.!6.,!p.8E9.!6!!See!Appendix!E:!Job!Descriptions.!

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something!didn’t!change!we!were!going!to!wake!up!someday!soon!and!just!walk!away!from!the!company.!!We!had!created!a!very!unhealthy!environment!thinking!we!were!doing!it!better!than!what!we!had!personally!been!a!part!of!in!different!traditional!managed!companies.!!The!business!had!been!growing!quickly!and!in!seeking!out!help!in!knowing!how!to!manage!a!growing!company!I!became!involved!with!Vistage!(vistage.com),!a!CEO!leadership!organization.!!It!was!there!that!I!became!exposed!to!other!management!ideas!and!ultimately!to!selfEmanagement.!!In!selfEmanagement!I!saw!the!opportunity!to!have!an!organization!that!people!were!accountable!and!had!a!sense!of!personal!responsibility!as!well!as!ultimately!a!ownership!stake!that!we!have!in!our!model.!!!!!!In!hindsight,!he!realizes!that!suboptimal!communication!training!and!feedback!delivery!are!constraints!to!moving!forward.!!!!!!!Lanny!Goldman!shared!the!following!selfEmanagement!concepts!(or!pillars),!with!MMI:!!

1. Customer/Vendor!Relationships!–!these!relationships!are!both!internal!and!external!to!the!company.!!We!see!coEworkers!as!customers!of!our!service.!

2. Education,!Training!and!Orientation!–!not!only!do!we!need!to!teach!the!job!skills!but!also!how!we!function!as!a!selfEmanaged!company.!

3. Feedback!Mechanisms!including!Open!Books!–!Understanding!that!feedback!at!all!levels!are!important!as!well!as!have!an!understanding!of!how!money!flows!in!and!out!of!the!company!on!a!monthly!basis.!

4. One!ProfitEBased!Incentive!Comp!Plan!–!All!employees!work!together!to!produce!the!profit!that!creates!the!profit!sharing!pool!and!all!share!in!it!equally.!

5. Internal!Customer!Performance!Reviews!–!Internal!peer!reviews!done!on!each!employee!every!six!months!on!an!ongoing!basis.!!

6. Hiring!&!Firing!Own!Team!Members!–!Teams!play!an!active!role!in!the!interview!process!bringing!on!new!team!members!as!well!as!identify!when!issues!need!to!be!addressed!to!the!point!of!removal.!

7. Setting!Own!Compensation!–!Employee’s!understand!what!they!bring!to!the!table!and!what!the!company!can!sustain!as!peers!review!salaries.!

8. Employee!Equity!Participation!–!Employee!stock!ownership!of!the!company.!!At!this!date,!MMI!has!implemented!the!first!five!elements,!and!is!working!on!the!sixth!item.!!Elements!seven!and!eight!remain!to!be!implemented!in!the!future.!!MMI!has!adopted!the!following!tools!and!techniques!to!drive!and!sustain!the!adopted!elements:!#

1. Facilitation#training#2. Communication#and#feedback#training#3. Basic#accounting#training#4. New#Hire#interviewing#training#for#team#members#5. ICF#(Internal#Customer#Feedback)#training#and#processes#6. IPP#(Individual#Performance#Plan)#training#and#processes#

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7. We#are#beginning#to#make#outside#coaching#available#to#everyone##While!Rich!and!his!colleagues!appreciate!the!benefits!of!adopting!selfEmanagement!principles!and!methods,!they!do!acknowledge!many!challenges!along!the!way.!!They!are!determined!to!get!it!right.!!The!key!questions!remain:##•!Is!MMI!truly!selfEmanaged,!as!it!describes!itself?!If!not,!how!could!it!be!further!organized!to!become!selfEmanaged?!!•!What!methods!or!resources!could!help!further!MMI’s!selfEmanagement!with!most!of!the!workforce!working!from!home?!!•!How!do!you!keep!a!remote!workforce!connected!and!engaged?!!!•!In!what!ways!can!communication!among!remote!employees!be!made!to!function!at!a!higher!level!to!enable!more!effective!selfEmanagement?!!•!How!can!MMI!improve!employee!financial!understanding!(especially!regarding!cash!flows)!in!order!to!move!the!business!forward?!#

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II.((Transition:(The(View(from(Inside(MMI!(( (( A.((The(Benefits(of(Abandoning(Command?and?Control(!Rich!describes!the!benefits!of!abandoning!the!traditional!commandEandEcontrol!organizational!structure!as!follows:!!Speaking!as!the!owner!of!the!company!I!have!to!say!the!biggest!benefit!that!I!personally!have!had!to!this!point!in!our!journey!has!been!that!I!don’t!need!to!answer!all!the!questions!any!longer.!!To!see!the!personal!growth!that!this!journey!into!selfEmanagement!has!done!for!me!has!been!outstanding.!!I!have!to!be!a!better!person!to!lead!a!selfEmanaged!organization,!I!am!a!daily!example!of!communication,!giving!and!receiving!feedback,!both!good!and!not!so!good.!!Seeing!the!personal!and!professional!grow!of!those!taking!the!journey!with!me!has!been!very!fulfilling.!!Several!MMI!colleagues!also!weighed!in!on!the!benefits!of!transitioning!away!from!commandEandEcontrol.!!Arlene!Miller:!!As!someone!who!was!here!when!we!first!started!self!management!and!then!I!was!gone!for!16!months!for!a!medical!absence,!I!came!back!to!a!much!more!noticeably!mature!organization.!!This!I!had!expected!since!I!started!out!in!the!pilot!team.!!What!I!feel!is!a!benefit!is!the!fact!that!so!many!more!people!are!more!verbal!about!their!opinions!and!needs.!!We!are!much!more!open!about!our!positions!and!what!we!do!every!day,!which!this!allows!us!to!learn!off!of!each!other.!!I!feel!more!a!part!of!the!process!and!decisions!for!policies.!!Makes!me!think!more!outside!of!my!own!job!duties!and!think!of!how!my!job!affects!my!coEworkers,!customers!and!clients.!!I!feel!that!this!has!allowed!us!to!become!stronger!and!better!at!what!we!do.!!!!Jackie!Chlebowski:!

!Being!that!we!are!a!company!of!satellite!offices,!it!helps!with!the!feeling!of!being!alone.!!Being!part!of!a!team!also!makes!it!easier!to!voice!concerns!before!you!are!so!stressed!out!you!become!counterproductive!in!work.!!!!Gwen!Rogers:!!My!understanding!of!what!it!takes!to!keep!a!company!running!has!broadened,!which!has!allowed!me!better!take!ownership!of!my!own!actions.!!Knowing!that!my!opinion!matters!and!is!taken!into!consideration;!learning!to!function!within!a!supportive!team!framework!has!been!great.!!The!security!of!knowing!that!there!is!someone!out!there!to!help!me,!even!when!they!might!be!hundreds!of!miles!away,!is!reassuring.!!It’s!great!to!be!a!part!of!developing!processes!that!affect!my!daily!work.!!

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Carrie!Pearson:!!I!am!a!control!freak!and!did!not!have!much!control!to!begin!with,!so!did!not!have!much!commandEandEcontrol!to!abandon.!!But,!from!my!perspective!on!the!“ControlEFreak!CEO’s”!benefits!of!abandoning!commandEandEcontrol,!it!appears!he!has!attained!some!benefit!of!being!able!to!work!toward!finding!a!balance!in!his!life!to!include!time!to!be!himself,!rather!than!just!being!the!business.!!Jackie!Wristen:!!One!of!the!worst!feelings!I!have!felt!in!a!workplace!is!that!of!worthlessness!or!the!idea!that!you!are!completely!expendable!and!replaceable.!!The!idea!is!to!have!employees!learn!to!do!their!job!the!way!they!are!told!and!then!have!them!show!up,!do!that!job!as!invisibly!as!possible,!and!then!go!home.!!Other!than!the!job!they!are!completing,!they!do!not!provide!any!other!service!to!the!company.!!By!giving!up!that!“command!and!control”!attitude,!our!company!has!now!made!a!strong!effort!to!let!its!employees!know!that!we!are!in!control!of!what!we!do.!!Our!opinions!matter!strongly!in!the!development!of!many!procedures!and!we!are!asked!to!share!our!experience!and!knowledge!to!aid!in!the!progress!of!the!company.!!We!are!made!to!feel!that!we!are!contributing!on!multiple!levels!and,!if!our!ideas!are!not!in!keeping!with!the!direction!of!the!company,!it!is!explained!in!such!a!way!that!we!do!not!feel!dismissed,!but!instead!come!out!of!it!even!more!educated!about!the!organization!we!are!a!part!of.!!!Sue!BaxterEPflederer!(CoEFounder):!!As!the!one!who!was!in!command!and!control,!I!have!appreciated!the!freedom!of!allowing!others!to!have!a!say!in!how!things!are!done!and!recognizing!that!I!don’t!have!to!have!all!the!answers.!!This!took!a!huge!shift!for!me!personally!as!I!always!felt!I!should!have!the!answer!and!it!all!depended!on!me…!!Allowing!others!to!present!their!ideas!has!brought!forth!ideas!that!I!would!not!have!had.!!!( B.((The(Greatest(Challenges(of(Transitioning(to(Self?Management(!Rich!describes!the!greatest!challenges!of!transition!as!follows:!!Personally!understanding!that!the!organization!is!a!mirror!of!myself,!I!didn’t!like!what!I!saw,!what!is!that!telling!me!about!myself.!!That!was!a!very!big!challenge!in!the!beginning!and!still!is!as!it!keeps!me!on!my!toes!and!in!personal!growth!mode.!!We!did!lose!30!percent!of!our!business!in!the!first!year!and!a!half!which!was!very!hard!but!we!learned!a!great!deal!from!it!and!are!stronger!today!because!of!it.!!Understanding!how!important!communication!is!as!a!selfEmanaged!organization!and!finding!out!ways!to!improve!it!when!more!than!half!your!staff!works!from!home!has!been!a!big!challenge!as!well.!!!!!!!!!Jackie!Chlebowski:!!Challenges!include!building!that!team/trust!feeling.!!Trust!is!the!most!important!factor!in!this!process,!if!there!is!no!trust!then!you!have!a!hard!time!being!able!to!keep!the!communication!fully!open.!It!takes!time!to!build!the!trust!and!cannot!be!rushed.!!This!does!

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make!things!feel!like!they!are!not!moving!as!fast!as!you!want!them!to!in!the!team!atmosphere,!but!once!you!have!it,!it!makes!things!great!!!!Challenges!also!occur!when!there!are!tough!subjects!to!broach.!!In!a!team!atmosphere!there!may!be!more!than!one!person!with!the!same!feelings.!!This!helps!with!one!person!not!feeling!attacked!if!there!is!that!team!atmosphere.!!It!also!seems!to!help!make!problems!resolve!quicker!as!there!are!multiple!people!with!a!broad!variety!of!ideas.!!Gwen!Rogers:!!Learning!to!deal!with!the!difference!in!personalities!when!trying!to!come!to!a!consensus!on!issues!can!be!challenging.!!Sometimes!it!seems!to!take!longer!to!make!decisions!because!there!are!multiple!people!that!play!a!part!in!that!decision!making!process.!!Learning!to!think!within!a!selfEmanaged!environment!is!a!daily!process.!!!Carrie!Pearson:!!Some!of!the!costs!and!challenges!the!organization!has!encountered!on!this!road!to!a!freer!organization!have!included!a!great!deal!of!turnover!as!colleagues!have!decided!that!they!do!not!wish!to!embark!on!the!journey!the!organization!is!taking!or!colleagues!have!been!found!to!be!unable!to!fit!into!the!desired!reality!of!the!company.!!It!has!been!challenging!to!change!from!the!“old!way”!of!thinking!to!the!“new!way”!of!thinking!and!maintain!that!change!at!all!times.!!It’s!involved!all!colleagues!being!diligent!in!questioning!their!thought!processes!and!attaining!the!opinions!of!teammates!to!verify!that!their!thought!processes!continue!to!be!in!line!with!the!desired!reality.!!Ken!Goldman:!!There!is!more!time!spent!in!nonEincome!producing!activity!(internal!organization!and!communication!activity)!which!may!produce!higher!revenues!in!the!long!run!but!in!the!short!run!represents!nonEincome.!!Jackie!Wristen:!!Not!everyone!fits!into!the!new!type!of!organization!we!have!become!and!resist!the!changes!that!are!necessary!for!the!company!to!grow.!!These!resistances!make!it!hard!on!the!employees!that!are!on!board,!both!in!lack!of!potential!forward!progress!as!well!as!overall!morale.!!Sue!BaxterEPflederer:!!Challenges!are!in!how!slow!it!is!happeningE!I!need!more!patience,!and!understanding!that!the!concept!didn’t!come!to!me!overnight!and!won’t!come!to!others!that!way.!!!( (

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( C.((The(Role(of(Trust(!Rich!goes!on!to!make!this!observation!about!the!need!for!trust!in!a!selfEmanaged!enterprise:!!Trust!is!very!important!!!Giving!people!the!space!to!understand!what!it!means!to!work!in!a!selfEmanaged!organization!takes!trust!on!everyone’s!part.!!Trusting!that!the!system!we!have!put!in!place!will!produce!the!desired!results.!!Jackie!Chlebowski:!!As!I!stated!before,!the!team!atmosphere!will!not!occur!unless!there!is!trust!in!the!team.!!The!trust!takes!some!time!to!establish,!but!once!it!is!there,!things!run!much!smoother.!!Gwen!Rogers:!!It!is!huge,!I!must!trust!each!person!within!my!organization!that!we!will!each!take!responsibility!for!our!roles!to!create!and!grow!this!company.!I!have!to!trust!the!process!that!is!in!place!or!change!it,!if!someone!is!not!pulling!their!weight,!and!needs!to!be!confronted.!Also,!when!I!know!I!can!trust!my!associates,!then!I!will!feel!more!comfortable!participating!fully!in!the!process,!as!this!removes!the!fear!of!being!judged!for!expressing!my!ideas/thoughts.!!I!just!finished!reading!Beyond#Empowerment.!!It!made!me!happy!that!we!have!started!this!journey!while!the!company!is!still!rather!small!by!comparison!to!Morning!Star,!but!I!guess!you!have!to!go!through!the!same!general!steps!no!matter!what!size!your!company!is.!!!!Carrie!Pearson:!!Trust!plays!a!great!role!in!the!organization.!!Along!this!journey,!I!have!said!multiple!times!that!“I’m!along!for!the!ride,!hands!in!the!air.”!!I!have!to!trust!that!the!Leadership!team!will!be!available!to!provide!direction!as!it!is!needed;!that!my!teammates!will!be!available!to!guide!me!and!provide!their!opinions!so!that!I!remain!on!the!path!I!need!to!be!on;!that!I!will!not!be!retaliated!against!for!voicing!my!opinions!as!I!have!them,!but!instead!have!open!discussions!to!find!the!best!direction!to!continue!on!the!path!to!the!desired!reality.!!!Ken!Goldman:!!My!personal!answer!to!this!is!trust!is!key!for!me.!To!move!ahead!with!selfEmanagement!and!provide!honest!input,!it!is!important!to!trust!my!coEworkers!as!well!as!the!owners/administrators!of!the!company.!!I!have!been!in!situations!before!where!it!was!promoted!that!my!honest!opinion,!discussion!and/or!ideas!were!desired!and!people!were!encouraged!to!speak!openly.!When!an!opinion!was!offered!that!was!contrary!to!the!general!view!or!not!what!someone!in!power!wanted!to!hear,!the!individual!was!personally!devalued,!snubbed!and!characterized!as!a!negative!person!or!someone!with!issues.!!The!result!was!that!the!individual!and!others!learned!quickly!to!pretend!(an!excellent!example!of!one!trial!learning),!only!offered!what!other!parties!wanted!to!hear!and!reinforced!the!consensus!of!the!people!in!power.!It!became!a!system!of!sycophants!masquerading!as!offering!candor.!!I!think!in!order!to!achieve!full!growth!potential,!trust!is!essential.!!!!

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!Jackie!Wristen:!!Trust!is!vital!to!the!organization.!It!goes!back!to!those!individuals!who!are!not!on!board.!When!they!do!not!agree!with!or!trust!in!the!direction!of!the!company,!the!mission,!the!purpose,!or!their!team!mates,!they!will!not!be!a!positive!contribution!to!the!company.!Those!individuals!who!have!accepted!the!new!company!and!what!comes!along!with!it!have!decided!to!make!the!effort!needed!to!aid!in!the!success!of!the!company!and!are!willing!to!take!risks!or!rely!on!a!little!bit!of!faith!to!help!the!company!reach!its!fullest!potential.!Trust,!or!lack!thereof,!determine!the!success!of!the!individual!in!the!company!as!well!as,!ultimately,!the!success!of!the!company!itself.!!Sue!BaxterEPflederer:!!Trust!is!hugeE!I!have!to!know!that!others!are!invested!in!the!same!outcome!that!I!am,!that!they!are!willing!to!meet!their!obligations!as!well!as!work!hard!to!make!the!organization!a!success.!!I!have!to!trust!that!others!have!a!“pure”!agenda!and!are!willing!to!address!issues!as!they!come!up!and!not!let!them!fester!which!hurts!all!involved.!!!!III.((Conclusion!!!As!he!envisions!the!future!of!MMI,!Rich’s!key!questions!are:!!•!Is!MMI!truly!selfEmanaged,!as!it!describes!itself?!If!not,!how!could!it!be!further!organized!to!become!selfEmanaged?!!•!What!methods!or!resources!could!help!further!MMI’s!selfEmanagement!with!most!of!the!workforce!working!from!home?!!•!How!do!you!keep!a!remote!workforce!connected!and!engaged?!!!•!In!what!ways!can!communication!among!remote!employees!be!made!to!function!at!a!higher!level!to!enable!more!effective!selfEmanagement?!!•!How!can!MMI!improve!employee!financial!understanding!(especially!regarding!cash!flows)!in!order!to!move!the!business!forward?!!!!!!!!!

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APPENDIX A: Mutual Expectations !WHAT YOU CAN EXPECT FROM MEDICAL MANAGEMENT INNOVATIONS Medical Management Innovations, Inc. believes in creating a harmonious working relationship between all employees. In pursuit of this goal, Medical Management Innovations, Inc. has created the following employee relations objectives: 1. Provide an exciting, challenging, and rewarding workplace and experience. 2. Select people on the basis of qualifications without discrimination. 3. Compensate all employees according to their performance and contribution to the

success of our business. 4. Review wages, employee benefits and working conditions regularly with the objective

of being competitive in these areas consistent with sound business practices. 5. Provide paid time off (PTO) and holidays to all eligible employees. 6. Provide eligible employees with health and welfare benefits. 7. Assure employees an opportunity to discuss any issue or problem with Leadership

Team members of Medical Management Innovations, Inc. 8. Take prompt and fair action of any complaint which may arise in the everyday

conduct of our business, to the extent that is practicable. 9. Respect individual rights, and treat all employees with courtesy and consideration. 10. Maintain mutual respect in our working relationship. 11. Promote employees on the basis of their merit. 12. Make promotions or fill vacancies from within Medical Management Innovations, Inc.

whenever practical. 13. Keep all employees informed of the progress of Medical Management Innovations,

Inc., as well as the company's overall goals and objectives. 14. Promote an atmosphere in keeping with Medical Management Innovations, Inc.'s

vision, mission, and goals.

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WHAT MEDICAL MANAGEMENT INNOVATIONS EXPECTS FROM YOU… Medical Management Innovations, Inc. needs your help in making each working day enjoyable and rewarding. Your first responsibility is to know your own duties and how to do them promptly, correctly and pleasantly. Secondly, you are expected to cooperate with management and your fellow employees and to maintain a good team attitude. How you interact with fellow employees and those whom Medical Management Innovations, Inc. serves, and how you accept direction can affect the success of your department. In turn, the performance of one department can impact the entire service offered by Medical Management Innovations, Inc. Consequently, whatever your position, you have an important assignment: Perform every task to the very best of your ability. You are encouraged to grasp opportunities for personal development offered to you. This manual offers insight on how you can perform positively and to the best of your ability to meet and exceed Medical Management Innovations, Inc. expectations. We strongly believe you should have the right to make your own choices in matters that concern and control your life. We believe in direct access to the Leadership Team. We are dedicated to making Medical Management Innovations, Inc. a company where you can approach any member of the Leadership Team to discuss any problem or question. We expect you to voice your opinions and contribute your suggestions to improve the quality of Medical Management Innovations, Inc. (Please take a look at the "Suggestions" Policy.) We are all human, so please communicate with each other and with the Leadership Team. Remember, you help create the pleasant and safe working conditions that Medical Management Innovations, Inc. intends for you. The result will be better performance for the company overall, and personal satisfaction for you. !!!!!!!!!!!!!!!!!!!!

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!!!

!!

2013(Annual(Plan(((I.( LONG(RANGE(PERSONAL(&(COMPANY(VISION(!Sue!and!I!want!to!continue!to!mature!the!company!so!that!it!allows!us!to!ability!to!begin!traveling!and!enjoying!our!lives!without!the!burden!of!the!daily!stress!of!the!company.!!!!II.( COMPANY(MISSION(!Medical!Management!Innovations,!Inc.!is!committed!to!meeting!our!customers’!needs!through!our!expertise:!by!being!accessible,!knowledgeable,!and!flexible.!!We!are!always!looking!for!ways!that!we!can!help!our!customers!ease!their!work!loads!and!provide!added!value!to!them!for!using!our!services.!!As!time!goes!on!we!will!develop!more!services!that!will!continue!to!benefit!our!current!customers!as!well!as!move!into!new!markets.!!BiElingual!case!management,!liability!case!management,!and!group!health!case!management!are!some!examples!for!our!current!customers.!!Employer!services,!insurance!agency!education,!and!elder!care!are!some!ideas!for!new!markets.!!!!III.( PIE(CHART(OF(MARKET(SHARE(

!There!were!200,000!work!injuries!reported!in!2011,!of!those!50,000!where!reported!to!the!commission!for!missing!three!or!more!days!from!work.!!Those!50,000!injured!workers!have!a!high!percentage!of!getting!referred!to!case!management.!!In!2011!we!received!494!referrals.!!!!!

(

# of Injuries

MMI

Appendix(B:(MMI(Annual(Plan(

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TOP(FIVE(COMPETITORS(S&H!Medical!Management!Services,!Inc.!

The!Alaris!Group,!Inc.!Triune!Health!Group!

Corvel!Coventry!Health!Care!

!IV.( KEY(STRENGTHS( ( ( ( KEY(WEAKNESSES(!! Flexible! ! ! ! ! No!Marketing!Strategy!! Team!structure! ! ! ! No!national!contracts!! The!“Can!Do”!attitude! ! ! ! ! !! Quality!Training! ! ! ! !! Fred!Factor!! SelfEManaged!organization! ! ! ! ! ! ! ! !!V.( YOUR(CORPORATE(STRATEGY(!

Grow!Medical!Management!Innovations,!Inc.!into!an!entity!that!is!able!to!function!on!a!day!to!day!basis!without!Sue!and!me.!!Over!the!next!year!to!have!a!Leadership!Team!running!MMI!on!a!daily!basis.!!Offer!outstanding!customer!relations!in!all!areas!of!contact!and!identify!new!areas!in!which!to!provide!outstanding!service!to!our!customers.!!Begin!to!identify!new!business!opportunities!in!light!of!the!national!health!care!climate.!

!VI.( KEY(CORPORATE(OBJECTIVES(!! Continue!SelfEManaged!Organization!Structure!! Hire!Sales!person!to!build!business!! Continue!to!Build!Leadership!Team!–!hiring!up!on!each!hire! !!VII.( KEY(PERSONAL(OBJECTIVES(!! Begin!building!personal!wealth!outside!of!MMI!! Begin!building!a!life!outside!of!MMI!!!VIII.( KEY(REVENUE(&(PROFIT(OBJECTIVES!!! 2012! $!!2,250,000! ! 3%!profit!! 2013! $!!2,750,000! ! 12%!profit!! 2014! $!!3,500,000! ! 14%!profit!! 2015! $!!4,750,000! ! 15%!profit!! 2016! $!!5,500,000! ! 15%!profit!!!!

Training programs:

Outline of Core Curriculum we are working on building out:

Case Management Director SOLAR Responsibilities The responsibility of the ISU of Case Management is to provide case management production capacity in response to forecast provided by SBU Leader(s). The ISU of Case Management monitors and evaluates recruitment, development, production capacity and quality of all case managers and communicates that with the SBU Leader(s). This position requires but is not limited to participation in hiring case managers, follow up on customer complaints, response to subpoenas, monitoring PTO, development of self-managing teams, consideration of bill review questions, report & description of activity review for self-managing teams, select letter review, case management liaison to leadership team. The position includes participation in the Leadership Team and requires close coordination with the other Leadership Team members. Do whatever is necessary to maximize customer satisfaction, employee satisfaction and the company’s interests. Limitations Maximum budgetary authority of $2500 without leadership authority No program implementation without a plan and budget approved by the LT

Talent Director SOLAR Responsibilities The responsibility of the Talent Director is to maximize the quality of recruiting of potential employees, maximize the talent development of MMI employees and thereby maximizing the long-term, sustainable relationships with both customers and employees and create the most value for the company. Specifically, the position involves designing, implementing and maintaining the MMI recruiting program - including advertising, interviewing and maintaining a pool of potential candidates. The position will serve as a liaison with Administaff on benefits, payroll and personnel issues. The position also includes training of MMI employees on the legalities of supervisory and personnel functions. The position includes participation in the Leadership Team and requires close coordination with the other Leadership Team members who are the customers for this function. Do whatever is necessary to maximize customer satisfaction, employee satisfaction and the company’s interests. Limitations No budgetary authority until a plan and budget are created and approved by the LT No employee hiring without a request and budget approved by the LT No substantive changes with Administaff without LT approval

President/CEO SOLAR Responsibilities The responsibility of the President/CEO is to create and maintain an environment that honors the customer, employee and company equally. Specifically creates and maintains a vacuum for building a self managing company. Creates and maintains a three and five year vision for the LT, creates and maintains accountability among the LT, accountable to shareholders for company performance, facilitator of LT meetings and office team liaison to leadership team. Do whatever is necessary to maximize customer satisfaction, employee satisfaction and the company’s interests. Limitations Cannot obligate company for more than $5000 without an approved capital budget