Kona Medical Consulting is named after Donovan Miske’s (our CEO) beloved dog. But before the dog and the company, he managed a wildly successful hospitality MSO. At a client’s request, he was asked to look into a failing medical clinic on the verge of bankruptcy as a courtesy. And the trajectory of his future was set in place.

This was the first challenging puzzle Donovan experienced, and he was captivated. He provided the company with a step-by-step game plan for success in marketing, finance, staffing, IT infrastructure, and current market trends based on the hospitality industry. This would later turn into our Business Wellness Exam. The report also revealed a massive embezzlement concern with the current office manager and a series of missing charges from surgical cases, which assisted the client in understanding the scope of the company’s risks. Over time, the hospitality-influenced approach evolved into one of the first formally recognized standards for “full clinic” operational health, which has since been optimized over a thousand times.

“The client asked Donovan to assume clinic management, and the journey began. The opportunity to learn an entirely new industry and solve new puzzles was so enticing Donovan sold his successful hospitality MSO and committed fully to the medical industry.”

Building an excellent team

Donovan dove into learning via MGMA, AAPC, local medical society, and countless online forums. He put this knowledge to the test in a short time. Donovan generated a plan to turn the clinic around. He built an excellent team and continued to build his expertise by visiting similar clinics around Michigan. Within one year, the clinic was financially solvent. A year later, the clinic had a million dollars in excess in the bank. Two years later, we bought all of the local competition.

Multiple organizations recognized the clinic’s uncanny success, such as the local and national Medical Group Management Association (MGMA). This recognition captured the interests of other clinics that wanted whatever secret sauce we had discovered. After turning three additional clinics into success stories – while simultaneously managing the original clinic – it was clear that an MSO approach was logical for the economies of scale and talent acquisition. Most of the team that built the first success story consolidated their talents to serve economies of scale to increasingly granular niches within the MSO.

Outsourced multiple service line agreements

A year later, we formed the first large-scale private MSO in Michigan, employing 20 people and reducing the overhead of our eight clinics (all physicians were shareholders in this enterprise) down to a mere 46%. Our clinics consistently outshined the competition regarding ACO quality scores, medical cost reduction, surgical outcomes, cutting-edge surgeries (we pioneered the DaVinci robot and single port program for three major hospital systems), and being the coveted medical employer in the area. People started to take notice of the growth.

We assisted two local hospitals that outsourced multiple service line agreements to our MSO and clinical team. This allowed us to form medical reinvestment strategies that swiftly acquired many of the local medical office buildings. Our organization became one of the most prominent sponsors for local charities, catching the eyes of newspapers and television. We formed health insurance, a direct primary care clinic (before DPC was a common term), and two residency programs, all within a year.

Own to form a consultancy

Our organization became so large and successful that we dictated how two local hospitals would operate, creating a power struggle neither hospital felt was sustainable. Therefore, one of the hospitals made an effort to purchase our MSO at such a rare price that the shareholders couldn’t refuse.

Instead of continuing to work with the hospital, Donovan decided to go on his own to form a consultancy, Kona Medical Consulting, to support other clinics and organizations in need. Though the company was named after his beloved dog, the most reliable, supportive, and lovable friend, the team made the original MSO that helped compile a strong company overnight.

After a year of unexpected success and demand, we discovered that Kona Medical Consulting’s clients needed more support. As we would consult a clinic that needed services such as credentialing corrections, we would identify the issues, outline the solutions, and provide some recommendations of vendors to our clients. However, these clients were dissatisfied with either their internal staff and our recommended vendors. This occurred so frequently that we reviewed our communications from the prior MSO and our client experience to find the best credentialing staff. We recruited them to Kona and provided their service to our clients with a negligible markup because we earned our money from the consultation fees.

One-stop shop for the entire operation of clinics

We repeated the process with revenue cycle management, IT service, call center, scribing, and every other service we provided. Without intention, Kona became not only an MSO but a one-stop shop for the entire operation of clinics. As we transitioned to an MSO, we attracted a new set of clientele that wanted us to assume complete management of their clinic due to our expertise and lower cost (we averaged an overhead of 41% for our clinics, which is within the 1st percentile per MGMA Data Drive), ability to pass off managing hiring, oversight, and all other minutiae that could take the focus away from providing excellent healthcare.

As our “full scope” MSO client list grew, so did Kona. In our first year, we had 5 employees. By year two,  we had a team of 40. Today, our team exceeds 200. We’ve developed proprietary systems and exclusive partnerships to support our clients better. Partnerships with services like HCC Coding Optimization and Legal Representation are provided to our clients at a reduced rate because Kona accounts for such a large percentage of their business. As Kona provided exceptional support to our Physician Clinic clients – either as a full-scope MSO or an a la carte provider – these clinics became recognized by larger organizations, like ACOs, IPAs, and POs.

Providing support to fringe programs

Our clinics were consistently easier to work with and higher performing as a large-scale physician organization, so they started to engage Kona directly to provide services to other clinics. Kona changed from a public-facing company to a white-label company, as we provided our services under the ACO that resold them to their Physician Clinic members. After our fourth relationship with an organization of this type, we were approached by one of the country’s best-performing ACOs and Physician Organizations to assist with their operations from an organizational and a clinical level.

We learned so much during this time, our MSO shifted from a clinic focus to an organization focus, providing support to fringe programs like the Direct Contracting Entity model and some new health plan models. The momentum carried into community mental health organizations, jail systems, American colleges & academies, new health plans, direct-to-employer models, and even academic programs with experimental drugs or surgeries pending FDA approval.

Contracted to work with healthcare systems

Our organization has been contracted to work with healthcare systems in other countries in a consulting and an MSO capacity. The journey has been rewarding. We have enjoyed eliminating the minutiae from the healthcare industry that takes away from the healthcare provider and patient relationship.

Our physician clients no longer feel like overworked note-takers or struggle to remain independent. We maintain strict client confidentiality to protect their interests and to promote your success.

We built our company to operate remotely, encouraging a project board-based operational mindset. Over a decade, we’ve encouraged virtual meetings to overcome the need for meetings by curating a massive compendium of task templates within a project-based operation.

This uniquely prepared Kona for the pandemic, which had zero effect on our ability to operate or provide service to our clients. Likewise, while clinics struggled to pivot their operations successfully or otherwise, Kona expanded its client base at an unbelievable rate. Our platforms, staff, partnerships, and operational model could handle the torrent of new client requests without concern. We future-proofed our organization and our clients, we try to do the same for our clients.

“Clinics that adopted the full-scope MSO partnership remained open without interruption and had their best three years in clinic history – some even bought out their competition as physicians threw in the towel or clinics struggled to find staffing or couldn’t adopt technology such as virtual visits, remote check-in, or cloud-based platforms.”

  • 4,000+ active clients
  • 12,000+ Physicians supported
  • 4 countries
  • 41% average overhead for clinic operation
  • 24% average overhead for organizational operation
  • Top 10th percentile: Our MSO clinics consistently perform at the top of the MGMA Data Drive
  • 30 Minute: Customer service ticket turnaround time
  • 1 Hour: Claim creation from note completion turnaround time
  • 18 Minutes: From the time of service to scribed note submission
  • Top 6th percentile: Our clinics perform at the top of the AACP coding performance.
  • 32-Hour Workday: We have employees across 4 time zones, creating a 32-hour workday.
  • We leverage the latest technology and, in some cases, design it ourselves
  • Our ecosystem creates an economy that eclipses hospitals, TPAs, and all MSOs systems.


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