Front Desk Burnout Is Real
Mark Llorente, a healthcare operations executive with a career across hospital strategy, population health, and value-based care, on what actually breaks when private equity-backed rollups try to scale fast, why every turnaround starts as a people problem, and his test for any new technology.
Key takeaways
- Over-optimizing the front desk quietly strips away the human trust patients rely on. Efficiency that costs the relationship is not efficiency.
- Most M&A failures trace back to a board, sponsor, and leadership team that were never aligned on realistic goalposts before the deal closed.
- Every turnaround starts as a people problem: rebuild morale and accountability before touching a single system.
- Value-based care is proactive by definition. Chase down the appointment and the referral before the patient is ever readmitted.
- The test for any new technology is whether it is an enabler of trust rather than a replacement for the people who built it.
- Run small, tested use cases instead of signing long contracts on vendor hype. Patients engage far more readily with AI on inbound requests than outbound outreach.
Consolidation was supposed to make healthcare operations easier. Buy the practices, centralize the back office, standardize the front desk, and the efficiency shows up on the P&L. Mark Llorente has spent his career inside that promise, across hospital strategy, population health, and value-based care, and his verdict is that the part everyone optimizes first is the part that breaks.
What consolidation did to the front desk
The front desk is where a patient decides whether they trust a practice, and it is also the first place a rollup goes looking for savings. Mark’s view is that those two facts collide. When the desk is staffed to a spreadsheet, scripted to a workflow, and measured on throughput, the person behind it burns out, and the patient on the other side feels the difference immediately.
Front desk burnout is real, and it is not a staffing problem you can hire your way out of. It is the downstream result of treating the most human job in the building as the most automatable one.
Disciplined integration versus a failed rollup
Mark has watched private equity-backed rollups from close range, and he is blunt about why so many fall apart. It is rarely the software and rarely the market. It is a board, a sponsor, and a leadership team that were never aligned on what realistic goalposts looked like before the deal closed.
Disciplined integration starts with that alignment. Which practices are being bought for their growth, which for their stability, and what changes on day one versus day three hundred. Without it, every operational decision downstream is made against a different scoreboard, and the people running the clinics are the ones who absorb the gap.
Turnarounds are people problems
Every turnaround Mark has led began the same way, and none of them began with a system. Morale first, then accountability, then process. Only after the team believes the place can work again does it make sense to change how the work gets done.
That ordering is not sentimental. A demoralized team will quietly route around any new system you hand them, and the dashboards will look fine right up until the patients stop coming back.
Trust across generations
Patient experience is not one thing. Different generations want different things from the same practice, and a front desk that is optimized for one will fail the other. Mark’s framing is to design for trust first and let the channel follow, so that every patient, whatever they walked in expecting, leaves feeling known.
What makes value-based care proactive
The habit that separates value-based care from fee-for-service is simple to describe and hard to sustain: go find the patient before the problem finds them. Chase down the follow-up appointment that never got scheduled. Close the referral loop before the specialist visit falls through. Reach the discharged patient before they are readmitted, not after.
Mark stays bought in on value-based care for a personal reason as well as a professional one. It is how he chooses care for his own family.
Technology as an enabler, not a replacement
Asked how he evaluates a new tool, Mark has a single test. Does it enable the trust between a patient and the people who care for them, or does it try to replace those people? Tools that pass the test give staff room to do the human part of the job. Tools that fail it make the front desk faster and the practice colder.
Cutting through vendor hype
Vendor pitches promise transformation; Mark asks for a small, tested use case. Pick one workflow, measure it, and expand only when the result is real. Long contracts signed on a demo are how practices end up paying for software their staff route around.
His most specific observation is about direction. Patients engage far more readily with AI when they initiated the contact, an inbound request to schedule, refill, or ask a question, than when the practice reaches out to them. Build for inbound first.
What excites him about the future
Mark closes on the upside of value-based care: the chance to spend the time and attention that fee-for-service never rewarded on the patients who need it most. As Kevin puts it heading into the close, perfect is a trap. Pretty good, shipped in front of the patient, wins every time.
Transcript
Read the full transcript
Whereas in the value-based care world, it is all about proactive engagement and proactive management. I'm not sitting waiting for anything, right? If you need an appointment, I'm gonna make sure you get the appointment. I'm not gonna wait for you to call me to get the appointment. You need the referral or you haven't seen the specialist. I'm not just gonna wait till the medical record comes in to confirm that you saw the specialist. I need to make sure that those dots are connected across the board.
You're listening to the Pretty Good AI podcast. Today's episode is about scaling healthcare without losing that human connection. Healthcare is getting more complex every year. More technology, more patients, more administrative work, and somehow less time for the people delivering the care. So, how do you improve operations without making healthcare feel less human? Mark has spent his career leading healthcare organizations through growth, value-based care, operational transformation, and some of the industry's toughest challenges. today we're talking about what it actually takes to work, where AI fits in, and why great healthcare still starts with the people. Let's get into it.
Thanks for having me. Yeah, I think the the biggest challenge that we've seen in the last several years is the massive explosion, evolution, just complete dominance of AI that's taken over, where so much of the experience is based on.
Trust that's established between providers and patients, between patients and the front desk staff. It is so humanistic, right? The interjection of technology, the injection of technology at such a fast clip tends to be challenging. And then you layer on top of that, I think, the the mass consolidation in the healthcare setting that we've seen over the last several years. What I call To some degree over optimization, everyone's trying to optimize, right? And there is a there is a point of diminishing returns where you optimize to a point where now the front desk staff who used to have time to engage with you know patient who walked through the door now has no time because there's only one of them. There used to be two or three of them, and now because technology is playing a different role. So I think to me, that's where the layers of complexity.
Tied specifically to patient-facing services, it is where it's more challenging on the technology side.
Yeah, awesome. You know, your career's kind of spanned, you know, hospital strategy, population health, value-based care. Like one of the things we're seeing is, you know, this kind of promise of like the MSO or private equity roll-ups. A lot of times, like they were supposed to kind of bring these operational efficiencies and see a lot of this, but now we're seeing a lot of those kind of stall out where maybe now AI gives them a cho a chance to actually be possible. What have you seen?
Yeah, I I would say from an MA perspective, incredible discipline in rigor discipline and being very clear-sighted as far as what it is that you're intending to acquire, what it is that it will take to be able to maximize value on the other side is critically important. Anyone who's been on i in healthcare in the last several years, in Ballet Consolidation, has been on the other side trying to integrate assets. And integrating assets is Hard enough as it is, integrating cultures, integrating infrastructure, integrating technology, and all that. But if on top of that, your goalposts are set so far out ahead of you that you've got no real shot of achieving what you're setting out to achieve.
And putting that aside, because it's not just what happens in things that you can't control, of the things that you can control.
How you set the course for what you're trying to achieve, how aware the board is, how aware your PE sponsors are, how aware the leadership team is as to what can actually be executed on, making sure that it's aligned, making sure that the group is aligned and that there's very clear expectations and checkpoints to hold people accountable is critically important. That tends to be what I've seen go wrong. Not clear vision or alignment of what of what needs to be achieved.
And what it will take to achieve it, and how you can weather any storm that comes in order to achieve it, because the storms are gonna come.
Yeah. When you're operating the scale of what you've done with dozens of clinics, multiple markets, it's incredibly complex. Like what are the operational challenges that you see sort of consume the most attention?
Yeah.
Yeah, I think the the greatest challenges that I tend to spend most of the time on are people-related challenges. and what I mean by that is when you have multiple markets, you have potentially multiple lines of business.
I think the biggest challenge is ensuring that teams are bought in. you walk into a market, and the team is completely debased as it relates to morale. They have just been punching a clock and manning a shot. So how do you take that same team? Because you can't just switch over a team and you don't necessarily have to. How do you take that same team and infuse them with a degree of energy, with a degree of accountability, with a degree of passion that's been lost?
To be able to kind of manage proactively the business again or for the first time. And that's very challenging. The most important part of that is being able to set clear vision and clear expectations. I often say that everyone wants to be on a winning team, right? But if you think you're on a losing team, the first and most important thing is for you to buy in that yes, we can be a winning team.
And I can help get us there. And this is the vision for how we're gonna get there. Let let let me build that trust with you, and then we're gonna get there together. it's it's a pretty powerful thing to see people rally around that and to see the performance, the metrics, the numbers shift very rapidly as that happens.
How about the patient experience? Like if you were gonna sort of like clean sheet or whiteboard, like a new patient experience, knowing what you know and what you've seen, like what would that patient experience look like and what would be the components of that that would make the most sense, you know, today?
I think the human connection is so critically important as it relates to patient experience. And and I I think it's not necessarily the same in across all age groups and across all populations that you serve, right? There are some populations of of individuals, especially younger generation who are busy working or what have you. They don't want to be contacted during the day. You can send them a text message, it's a quick yet, they'll respond, quick whatever it is, and and you're good.
They'll respond with, you know, confirming an appointment that's done. They'll they'll engage you and and leveraging AI, technology, or what have you is not an issue for the most part. There are some areas where it is. I think with an older population, it's a very different dynamic.
But either either way, as you get older, your faculties tend to diminish some, right? Your ability to pick up a phone, to see the screen, to understand, to hear, to see, right? All of those things are impacted. So having trust with the provider that or the group that you're working with is critically important. And again, I think with all the change that's happened, new groups have come in, the consolidation.
You know, Company A Mothership has bought six, seven, eight, nine new you know, groups, rolled them up, now they're layering in the kind of master mothership brand and they're swapping people out and they're cutting resources. And so Sally Smith, who you used to know, who you pick up the phone and call, the MA who you used to, you know, connect with every single time that you went into the office, she's she's no longer there. How do you navigate that? I I think for me.
There is a point where you have to go back to basics. And I do think that especially for leaders in healthcare right now who are navigating techn how much is too much technology, how much is not enough technology, how much is too much, you know, optimization or workflow redesign or what have ultimately if you pair it all back to some degree, it's pull it back to the basics. It's about a patient trusting the team that they're working with. what needs to get done will get done for them in the most timely manner that can possibly be done, and that their needs are gonna get resolved. If you can start there and work your way out, that to me would be where I would start. Yeah.
Yeah. What operational habits like separate the organizations that succeed under these risk based models versus ones that don't?
Yeah, I I think Having team members across the board, frontline all the way through to leadership, who are fully bought in and understand what you're trying to achieve is important.
And and I think especially on the front lines where you've got more turnover, you've got folks that are coming in without value based care experience who don't understand. They're coming in from a more reactive point of view, in more of a fee for service commercial based setting or what have you, which is whatever the patient wants, the patient gets. We're here to cater to them, right?
Whereas in the value-based care world, it is all about proactive engagement and proactive management. I'm not sitting waiting for anything, right? If you need an appointment, I'm gonna make sure you get the appointment. I'm not gonna wait for you to call me to get the appointment. You need the referral or you haven't seen the specialist. I'm not just gonna wait till the medical record comes in to confirm that you saw the specialist. I need to make sure that those dots are connected across the board.
And so I think the more leaders can take Real practical examples and set the course for the teams that are on the ground. Sit with them, talk to them. Go out and visit a patient with them. Like literally go to the home. Have some of those more challenging conversations for patients who are not compliant, who don't want to be seen, right? With the frequency you need to see them. I think that starts to change the paradigm where now there's accountability.
And now I, as an individual, frontline FTE feel empowered to pick up the phone and take action, to get out of the office and take action. And and the proactive versus reactive to me is really what sets VBC apart from the traditional model.
Knowing that you've spent so much time in each and understand them, like for your own family or your own health, like, you know, what is the best system?
If you had a choice, like would you pick one practice or one approach versus another?
Yeah, I think I I have been and am fully bought into value-based care from day one. I think philosophically I was bought in. I think the last many years of experience make me that much more bought in. But I struggle with it the way that every family does. I'll give you an example, right? My wife, anything happens with any of my kids, and the first thing her her gut reaction is to want to run to the hospital, right? To want to run to the emergency room.
And that we have those interesting conversations when things like that happen because I understand she she's coming at it from a different place than I am, and obviously I'm concerned as a parent, but my value-based my my whole hardware has been now switched so that my first question is, okay, if it's not an emergency, let's call the doctor.
Get the guidance that we need before we just automatically run to the hospital and seek the highest level of care. Because that may not be appropriate.
Putting aside the some of the challenges and barriers to more adoption of value-based care principles, I absolutely 100% fundamentally agree and think that value-based care drives real, demonstrable outcome improvements for patients and families. Yes, it drives savings. And and the the financial piece is important because without it, there's no incentive to do it, right? It's just a fact. But Anyone who's been in hospitals knows as great as a hospital can be.
Nobody wants to be there unless you have to be there. You want to be home. Yeah. Right? You want to be in with your loved ones in your in your setting. So for us, there's nothing that gives me more pride when you see that. And that's where now you start connecting dots for team members saying, hey, remember Sally Smith, who was in and out of the hospital all the time? We've got her stable and we've got her on this regimen. Look, she hasn't been in the hospital in three, four, five, six months. We're doing something right. Right. So that that to me is is really what connects all the pieces together.
Yeah, it's cool. I mean, you've said that technology really should be an enabler, not a replacement for people. Like, how does that philosophy sort of look like in practice?
Yeah, I I think there is a knee-jerk reaction, at least what I've experienced, there's a knee-jerk reaction to assume that because technology can perform X function, that it the person who's doing that function no longer needs to be there in order to do that function. there are instances where that's absolutely true. And there are instances where you lose something that the human had with connection that you couldn't get with the technology. Right. so I I my view of technology is again, in especially in a patient care setting where that interpersonal relationship is so critical, building that trust is so critical. keeping that trust is so critical not just to keep the patient your patient but also for the purpose of outcomes if the patient trusts the provider and trusts the staff when you call they're gonna pick up the phone you don't need to go to the hospital I'm telling you come see me you don't need to go in I can take care of that for you they'll listen right Whereas if there's no trust, they don't listen. So the trust piece is critical. To me, the technology has to enable and facilitate that trust and those promises to be made true. And if if that's the starting point of the technology, I think it it works flawlessly.
There's a whole host of back office. And there's even on the engagement side, just from practical experience, just a quick anecdote, what I've seen is on the inbound side, if a patient is calling you because they need something, they are much more willing to and able to work with technology to get their answer for whatever question they have or to get the solution to their issue.
However, on the outbound side, if I, as the provider, am using technology to outbound call people, and they don't need anything from me, the likelihood of that adoption is not as high. It depends on the population.
My perspective is if going in as a leader, you're looking at technology as an a as an enabler, not a replacement, the framing of that, just the mental framing of that when you go in to look at a solution is absolutely critically important.
think, you know, every vendor claims they've kind of found this holy grail. Like, in your experience, like what is it that sort of separates that like meaningful innovation from some kind of a hype, you know, it's just marketing promise? Like how have you sort of like, you know, sort of distilled that down to what's actually impactful for an organization, whether it's something to try or something, you know, as you're sort of rolling it out?
Yeah. I I chuckle a little bit because I think the starting point of every technology conversation is it's all hype. Like that's the assumption. It's all hype. I'm
Yeah.
not I'm not because we've heard the story enough about how
Course.
this can solve X, Y, and Z. And hey, we've rolled it out with X, Y, and Z and look I would hear it with and then you dig in and you realize it's it's a a facade. And I I'm not saying it's the case everywhere, but and again with the Evolution of technology, it's it's happened so rapidly that now you got excited about AA, and then six months later B comes out, and it it it's challenging, right? So I think for me, it's always what's the problem we're trying to solve? Right? What what is and how can this solution help to solve it? Have they solved it already? Or are they trying to learn how to solve it with us?
I think establishing clear parameters of like realistic expectations and then building out some use cases, not going all in too early or too fast. Test it and see if in the early phases what you're testing works, and then you expand the relationship from there. a lot of people have spent a lot of time, especially over the last 10, 15 years, trying to build as a provider group or as a health system your own technology stack, which was gonna be the holy grail.
And after spending tens and tens of millions of dollars trying to build that, realize they're no better than they were when they started. So
Yeah.
whether you're building it yourself or you're adopting it or leveraging it from a third party, I think being very clear on what you're trying to achieve and what you're trying to be and not to be, is is very, very important. Yeah.
Yeah, it's good.
How important is sort of how that technology is delivered?
And I'm curious for you, have you seen that shift over the years, or is it still pretty common that healthcare
Okay.
technology is really trying to s kind of, you know, I wouldn't lock you into strong word, but like present you with a multi-year sort of like, how do I get on like a really big contract before we even do the work?
Yeah, I would say that's just not happening now, longer term contracts, nobody's I haven't seen folks willing to sign multi-year contracts, even 12-month contracts, without you know, real demonstrable outcomes. and even then, they tend to have pretty generous out causes because technology is evolving so fast that The day of tomorrow, what you're doing today, that's really great. There's somebody that's doing it better. And so it's it's it's it is a challenge, not just for you on your side, but I think for you know, healthcare leaders on the other side who are trying to make sure that they're doing the best that they can for today without boxing themselves out to what can be better tomorrow. Right. And and so it it is challenging. But I think that's also where again the trust factor comes in. It's not just with Patience, it's with your vendors. And that's a hard thing because there's not a lot of trust there. so long as there's that degree of trust, I think folks can work together.
The frank reality is in a in a corporate setting, I think I think trust trust is the must, not just with the patients, but also with the the the additional stakeholders who are valuable, like technology partners, who are valuable in delivering the end product to the patients that you serve.
Looking ahead, like, what excites you most kind of about the future of healthcare?
I'll say I mean I've in the last five years, I think the adoption that I've seen at a very local level of like grassroots table stakes, baseline value-based care understanding, and and owning it and and and allowing that model to become part of the the the the clinic's DNA, the staff's DNA, that to me is has been incredibly exciting to see. I think, you know, five years ago, 10 years ago, there was we're sitting on the fee for service side of the fence. And yeah, you guys can talk about that value-based stuff all you want, but you know, too bad we're not and I think now, and in and by the way, you know, But I am excited to see how the run-of-the-mill frontline team members are proactively engaged in a way that I hadn't seen prior to really help deliver outcomes at a very local level.
Awesome. Mark, this is great. Where can listeners kind of follow your work or connect with you?
Yeah, I I LinkedIn is probably the best bet. it tends to be where I where I'm most active as it relates to to business and and my thoughts on healthcare and all that good stuff. So linkedin would be it.
Awesome. Mark, the fantastic conversation. Thanks so much for joining us.
Thanks so much, Kevin. Thanks for having me.
Well, that was a fantastic sort of discussion of value-based care and sort of thinking about technology. Sort of the five key things that Mark I and I came away with. I think one, consolidation over an o an over-optimized front desk. Really, you know, it's sort of that human layer goes away when you just reduce the number of people that can actually interface with patients on a day-to-day. Lots of MA failures come from these unrealistic goalposts, just setting out a misalignment between the board, the sponsor, and the leadership. Third, Turnarounds are really people problems. You gotta get the team on board, fix morale first before looking at changing things or adding technology. Value-based care really wins on that proactive frontline behavior. How do you chase appointments and referrals and get the patient on the phone in the office and have that appointment before they sort of get readmitted back to the hospital? And I think Mark was properly skeptical of like vendors that sort of lead with hype. You know, start small, prove the outcome.
Stay away from multi-year contracts and really get focused on the actual sort of deliverable workflow and the and the real technical improvement that you can get. And then finally, Patients engage with AI much more readily on inbound. So always best to start there and then layer in outbound as it makes sense to reach out and engage or re-engage patients to sort of complete that. So if you're leading a healthcare organization today, managing multiple clinic locations or thinking about how AI fits into value-based care.
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And that's the show. Perfect is a trap. Pretty good. Shipped in front of the patients. Wins every time. See you next episode.
Transcribed from the episode recording, with names and spellings corrected.