Source: https://mancuso.ai/project/smilemd-technology-strategy/ Work ## Products built now. _Results on record._ Two products being built with teams of AI agents, and two decades of leadership case studies grouped by the problem they solved. Each one covers the situation, the decisions I led, and what changed. ## Built with teams of AI agents Two products, each with an overview and focused case studies [![A dental operatory with the Pixie Dental interface open at the chair.](https://mancuso.ai/images/site-architecture-pixie-operatory.webp)In development![Pixie Dental](https://mancuso.ai/images/brands/pixie/pixie-dental-horizontal-blue.svg)An end-to-end platform for dental practices.Front desk, clinical charting, insurance, checkout and reporting on one FHIR-based record. Built by a small team directing AI agents inside governed foundations.Product overview](https://mancuso.ai/build/pixie-dental/) Case studies 1. [Designing the constraints that made parallel development work](https://mancuso.ai/build/pixie-dental/constraints/) 2. [Delegating substantial delivery to agents, and checking it](https://mancuso.ai/build/pixie-dental/delegated-delivery/) [![A Phase 3 Benefits payment card on a paper background.](https://mancuso.ai/images/site-architecture-benefits-card.webp)App Store deployed · Preparing for commercial launch![Phase 3 Benefits](https://mancuso.ai/images/brands/phase-3-benefits/phase-3-benefits-wordmark-black.svg)Eight benefit accounts on one card.Health, commuter and wage-law benefits on a single payment card, with a member app and an admin portal. Run by one person directing AI agents across product, engineering and compliance.Product overview](https://mancuso.ai/build/phase-3-benefits/) Case studies 1. [A second brain that keeps the plan honest](https://mancuso.ai/build/phase-3-benefits/second-brain/) 2. [Agent-operated infrastructure, through one toolkit](https://mancuso.ai/build/phase-3-benefits/sysadmin-toolkit/) The through-line The judgment comes from the record below. _The way the work gets executed has changed._ Product & technology leadership ## Leadership results, by problem Search case studies Showing 6 of 43 ![SmileMD](https://mancuso.ai/images/companies/smilemd.png) ![SmileMD](https://mancuso.ai/images/companies/smilemd.png) Case study · 2021 # SmileMD Technology Strategy Building on Constraints and Customer Journeys to Grow Patient Volume 5x annual patient volume, 5K to 25K 5x revenue in the final year 2x strategic levers 3 ![SmileMD Technology Strategy, SmileMD, 2021. 5x annual patient volume, 5K to 25K. Case study by Michael Mancuso.](https://mancuso.ai/og/smilemd-technology-strategy.webp) Crafted SmileMD's technology strategy around the theory of constraints and customer journeys, defining an IT North Star with three levers and named measures, and built the function, process, and technology that supported the company as annual patient volume grew from 5,000 to 25,000 and revenue doubled. 01 ## Challenge SmileMD, a venture-backed healthcare technology-enabled services company serving patients across five states, was growing quickly with no technology function behind it. As the company's first Chief Information Officer, I had to establish IT, engineering, product, design, and business intelligence from the ground up, and I needed a strategy that would tell a new team where to invest. Patient volume was the business; the strategy had to explain how technology would increase it without sacrificing quality, and it had to be measurable enough that every team could see whether its work was moving the company's north star. 02 ## Action I built the strategy on two ideas, the theory of constraints and the customer journey, and expressed it as an IT North Star the whole company could use: - **Company North Star:** Anchored the strategy to the company's north star, to increase patient volume while improving quality, measured by patients per day, patients per case day, patient cancellation rate, and case day incident reports. - **Customer Journeys as the Map:** Mapped how providers, practices, and patients experienced the service, the work later detailed in the Service Design case, so that friction and constraints could be located rather than guessed at. - **Theory of Constraints as the Lens:** Treated capacity constraints as the primary limit on growth and directed technology investment at relieving them in order. - **Three Strategic Levers:** Stated the technology goals as three ways to increase patient volume: reducing customer friction, alleviating capacity constraints, and supporting new service lines. - **Named Measures for Each Lever:** Defined how each lever would be measured. Customer friction by customer acquisition cost, lifetime value, first contact resolution, and net promoter score. Capacity constraints by recruiting velocity, sales velocity, and capacity and efficiency per capability. New service lines by time to market, total cost of ownership, and impact to shared services. - **Strategy into Roadmap:** Translated the levers into the Outcomes-Driven Roadmap, with goals and success metrics for providers, practices, patients, payers, and teammates, so that teams calibrated their work against the strategy every sprint. 03 ## Results The strategy gave SmileMD a technology direction that compounded: - **5x Patient Volume:** In my final year, annual patients served grew from 5,000 to 25,000 and revenue doubled, reaching $12M a year, while gross margins held. The strategy did not produce that growth on its own; it set the direction, and the function, process, and technology built against it carried the scale. - **Three Levers, Each Executed:** Customer friction fell as providers and practices gained self-service, with an 81% reduction in provider requests and a 96% reduction in practice requests through the Provider App and Practice App. Capacity constraints eased as patient-clearing cycle time fell 50% through the Care Coordination App. New service lines were supported on a platform built to scale, with Salesforce Health Cloud cutting cycle times for dozens of tasks by 80%. - **Measures That Held:** Because each lever carried named measures from the start, the Outcomes-Driven Roadmap could report results against goals, and the team exceeded every roadmap target. - **A Function Built to the Strategy:** IT, engineering, product, design, and business intelligence were established from the ground up as a team of 15 organized around the levers, including the BI practice that identified and recovered $1.3M in missed billable claims. ## In their words Recommendations from people who were there, in their own words. > Michael's ability to collaborate effectively with our team, fostering an environment of mutual respect, ensured that our technology solutions were aligned with clinical needs. Dave Keseg Physician executive leader Medical-team colleague · SmileMD March 2023 > I had the pleasure of seeing firsthand the caliber of leadership Michael demonstrated as CIO at OFFOR Health and was incredibly impressed with the product results he and his team delivered. Alejandro Ramos Enterprise Healthcare COO Cross-functional colleague · OFFOR Health March 2023 > Throughout our time working together, I was consistently impressed by Michael's ability to motivate and guide our team towards success. Faith Biddle Founder & CEO, GenAIsis Cross-functional colleague · OFFOR Health April 2023 > Michael had such an impact that I re-located to Columbus to join his team at OFFOR Health, where I have seen firsthand why people love working with him. Joshua Beron Analyst / Agilist / Co-Founder Direct report · OFFOR Health; colleague · Kapitus January 2023 > I had the privilege of working for Michael at OFFOR Health, where I discovered that he possesses exceptional vision and extensive expertise in technology and processes. Timothy J Korona Retired Direct report · OFFOR Health March 2023 > However, his exceptional leadership skills are manifested in his ability to establish meaningful connections with team members, impart knowledge, care for his teams. Abdijalil Dini Full Stack Developer Direct report March 2023 > Michael challenged me to solve problems differently, think strategically, and to identify paths forward that not only served today but set the team up for success in the future. Amy Brown Director of Customer Delivery at AssistIQ Direct report March 2023 > He doesn’t just make sure jobs get done, he makes sure the goal is accomplished. Anthony Domine Direct report March 2023 > He also has a rare combination of strategic brilliance and operational excellence - in plain speak he can define the mission, rally people around it, and also execute against it. Ben Thorp Software Engineer Engineering colleague · multiple engagements March 2023 > But, what makes him a phenomenal leader is his ability to connect with others, teach, care for his teams, and lead by example. Erin Ray Nurse Practitioner at Curana Health Direct report March 2023 > His logical, common sense approach makes even the most daunting tasks achievable. Under his leadership, his team's execution is aspirational. Greg Holloway Manager, Financial Operations at Cardinal Health Cross-functional colleague April 2023 > The speed in which he was embraced by the business/stake holders was incredible to watch. Jason LeGris AI engineering / Engineering Leader Cross-functional colleague February 2019 > Michael was always there to brainstorm ideas, aid in identifying real problems needing solved and always put a plan to action. Katlyn Dixon Manager, Member Engagement Cross-functional colleague January 2023 > He is a people-first leader and mentor who is always looking to make improvements and push the boundaries of what's possible. Kenya Chatman DEIB Leader, HR Professional, Career Consultant Cross-functional colleague March 2023 > If you are looking for a visionary leader who can help you transition from the ‘abstract’ to the ‘concrete’ swiftly and drive outcomes efficiently - look no further. Kunaal Mathur Vice President - Strategic Sales Salesforce partner · Michael was his client March 2023 > Working with Michael we were able to strategize, collaborate, identify problems, and achieve solutions. Meghan Seibert Credentialing Manager at Ohio Health Direct report November 2022 > He really challenged the status quo and has the vision and execution to achieve lofty goals. Mehreen Khan Commercial Account Executive at Salesforce Salesforce partner · Michael was her client March 2023 > Michael is the definition of a strong CIO - not only does he have the expertise (especially in healthcare), but he is also a very strong leader of people and developer of talent. Mike Glick CEO of NIMA Partners Cross-functional colleague April 2023 > He understands the technical elements of product development and can communicate this to both technical and non-technical stakeholders. Nick Knapp Experience Designer / Front-End Developer Direct report · two product teams January 2023 > He is an exceptional leader and always tried to put the people doing the work first. Vaskeysa Cooley Senior Director, Revenue Cycle & Payer Network Strategy Cross-functional colleague May 2023 1 / 20 ## Related case studies - [SmileMD: An Outcomes-Driven Product Roadmap](https://mancuso.ai/project/outcomes-roadmap/) - [SmileMD: Designing a Connected Service](https://mancuso.ai/project/service-design/) - [SmileMD: $1.3M in Missed Claims Identified and Recovered](https://mancuso.ai/project/business-intelligence/) - [SmileMD: 81% Fewer Provider Requests](https://mancuso.ai/project/smilemd-provider-app/) - [SmileMD: 96% Fewer Office Requests](https://mancuso.ai/project/practice-app/) - [Care Coordination: 86% Fewer Defects](https://mancuso.ai/project/care-coordination-app/) ## Questions What were the three strategic levers in SmileMD's technology strategy? Reducing customer friction, alleviating capacity constraints, and supporting new service lines, each defined as a way to increase patient volume while improving quality. How did the theory of constraints and customer journeys shape the strategy? Customer journeys for providers, practices, and patients located friction and constraints; the theory of constraints directed technology investment at relieving the binding constraint on patient volume first. Which case studies show the strategy being executed? The Outcomes-Driven Roadmap, Service Design, Provider App, Practice App, Care Coordination App, Salesforce Health Cloud, and Business Intelligence cases each carry out one or more of the levers. What business result did the strategy produce? In Michael's final year, SmileMD's annual patient volume grew from 5,000 to 25,000 and revenue doubled to $12M a year while gross margins held. The strategy set the direction; the team, process, and technology built against it supported that scale. ## Start with the problem, _not the proposal._ Talk with me about what you need to build, fix, or decide. We’ll explore how Phase 3 Services can help and what an engagement would involve. [Schedule a conversation](https://scheduling.mancuso.ai/scheduling/)[Engagement types](https://mancuso.ai/services/)