[Editor’s Note: Introducing Founder Forum, a new feature for Maine Startups Insider. Each week I’ll publish an interview with a startup founder in Maine. This series of interviews is sponsored by the Maine Technology Institute. Read more about MSI’s sponsored content strategy here.]
Dan Mingle, as you’ll learn below, never thought of himself as an entrepreneur. He was just a doctor who while running his own physician practice in Norway, Maine, for more than a decade recognized a need for a more efficient healthcare system. Instead of being content with the lack of a solution, he saw an opportunity to execute on his ideas and play a part in improving the healthcare system and helping physicians like himself.
“You might say that I’m in the business of providing for my clients those things I wish I had when I was in practice,” Mingle told Maine Startups Insider.
After stints helping MaineGeneral implement an electronic health records system (where he gained national recognition, being named innovator of the year in 2008 by Healthcare Informatics magazine) and consulting with other healthcare organizations, he founded Mingle Analytics in 2012. Though his experience was in the implementation of electronic health records, his company soon found a niche helping healthcare providers comply with relatively new federal Medicare reporting requirements.
Proving wrong the naysayers who said growing such a company in rural Maine wasn’t viable, Mingle Analytics now employs 63 people and is still based in South Paris, Maine. It raised a $900,000 seed round in early 2016. Investors include Maine Venture Fund, Coastal Ventures, Boston Millenia Partners, and angel investors from both the Maine Angels and the angel investment group in Bangor. Mingle said the company is planning to raise a Series A sometime later in 2017.
I spoke with Mingle about how he overcame the challenges of growing a business in rural Maine, why he’s deliberately remaining unprofitable, why he thinks the most innovative thing the company is doing might have nothing to do with healthcare, and his lessons for other aspiring entrepreneurs in Maine. The interview has been edited for clarity and length.
MSI: Have you always thought of yourself as an entrepreneur?
Mingle: I think I never used the term entrepreneur. I’ve always been a businessman. I was raised in a retail environment. My father owned a general store in rural Pennsylvania, where I worked from the moment I was old enough to empty trash cans or do other things of value around the store. I think we weren’t allowed to run the cash registers until we were 10. But I was raised on things like the customer is always right and a service philosophy. I fled the retail environment to go into what I thought at the time was a higher calling—medicine—only to find the service ethic in healthcare pales beside many of the retail service ethics I was exposed to before. When dad offered me the store way back when and I said, “No, thank you,” one of the things in the back of mind was I didn’t want to define the quality of my career as my ability to sell people things they didn’t need at prices they couldn’t afford—even though that’s not what my father did. But when I took stock of my life as a physician and practice owner many years later, I realized I was selling people things they didn’t need at prices they couldn’t afford: MRI scans when they’re not necessary, things like that, the classic excesses in the practice of medicine. That kind of pushed me down the career path of correcting those oversights.
My father never ran out of hardware on his shelves or things people need, whereas we commonly in healthcare put people off when they need help today. We tell them we don’t have room for them today, come tomorrow or next week. That never made sense to me. So I’ve been trying to correct those problems since I identified them in my practice 20, 30 years ago.
You ran your own physician practice for a long time, so you’ve been an entrepreneur for most of your professional career.
Exactly. I’m willing to work for other people, but even as an employee I tend to be a pain in the ass. [At this point, Mingle laughed] No, no, that’s not it. I tend to be a self starter and I’m as inclined to fire my employer as anything. So I’m not at all averse to moving on. I’m not trapped by a job. So, I’ve never thought of myself as an entrepreneur, but I’m certainly independent and when I found this need in the market there were no barriers to me just saying: “Oh, this is what I’m going to do.”
Whereas your first business was as a consultant to help healthcare organizations implement electronic health records using existing software, Mingle Analytics is different in that you decided to to create your own software products, correct?
Yes, though the decision wasn’t to create a set of technology products. It really is a solution we’re providing and the products and services are part of that solution. That’s something in entrepreneurial circles some of my mentors have had trouble getting their arms around. Many people decide to be entrepreneurs and then they’ll look for a product. I found a need and I’m filling that need.
[Whereas Mingle focused on implementation of electronic health records at MaineGeneral and in his first consulting business, a new need emerged in the late 2000s when Medicare introduced a new quality reporting system. Mingle built his first Physician Quality Reporting System, or PQRS, while still at MaineGeneral. It was initially introduced with little incentive for physicians to use it, but that changed with the introduction of penalties for non-use around the time he started Mingle Analytics.]
Although my intent with Mingle Analytics wasn’t to specialize in PQRS, the reality is I had to. The penalties were driving participation rates far higher than they were in my earlier business and by offering that service and doing a good job, we really had no time do anything but. My interests remain as diverse as they were when I was at MaineGeneral and in the first business. I still have interest in optimizing electronic medical records, restructuring practices around optimum use and better delivered healthcare services, using information systems for quality improvement and quality assurance. Those are some of the things I’m interested in, and good at, but because there’s so much need to comply with Medicare requirements, we‘ve been growing so fast that I haven’t really had the leisure to do anything but struggle to keep up with demand for this reporting services.
Can you tell me a bit about how fast you’ve been growing?
Probably the best thing is to track by numbers. Medicare reporting requirements are based on a service year. Healthcare providers are required to provide data on the service year in March of the following year. So 2012 was the first service year and we submitted data to Medicare on March 31, 2013, on behalf of about 40 practices representing 500 individual healthcare providers. The most recent year we finished was the 2015 service year, which we submitted on March 31, 2016, on behalf of 2,000 practices representing 32,000 individual healthcare providers in all 50 states. We are the second largest company of our kind by submission volume in the nation—run out of South Paris, Maine.
Are you profitable?
We’re deliberately unprofitable. We’re spending every penny we get in revenue and we can get in funding to build for a bigger next year, and we’re continually doing that. I’m keeping myself as unprofitable as I can afford to be in order to sink everything into growth. We’ve got an incredible future ahead of us and an unprecedented opportunity to get market share. This is a new stress in the United States. It’s a new industry and we are a leader in that industry. I don’t intend to relax to collect and live high on my profits when I can build a bigger, better business.
Are you able to provide revenue figures, even if just a ballpark or range, to give us a sense of the scale we’re talking about?
Let me just say we exceeded $5 million in revenue in our most recent submission season. We would be profitable if we were willing to restrain our growth to no more than 50% a year. But with aspirations to grow faster than that we are reinvesting everything we make, and get in funding, back into the company.
Besides growing up in an entrepreneurial environment with your father running his own business, did you need to seek out help or mentorship when you decided to launch your own business?
Not so much on the first [consulting] business. In that first business I partnered with someone who had more recently been running a large business and expected to get a lot of that operational guidance. I may have done much better in my first company had I sought help. With Mingle Analytics, I looked for more help. I stumbled across the Maine Center for Entrepreneurial Development, and I engaged there. I engaged SCORE in my local community and then got connected to some of the Portland resources of SCORE. Then I came across the Maine Technology Institute and availed myself of their help and resources. When I was more active as a physician I was a junky for physician leadership programs. Now that I’ve been focusing on building the business I’ve moved from physician leadership to entrepreneurial circles. I’ve been active with SCORE, MCED, MTI and still avail myself of those resources fairly regularly and successfully. I think it’s been key to the higher success that I’ve been enjoying in this business than in my previous business.
Is it safe to say you’re not sure you’d be where you are today if you didn’t have access to those resources?
Yeah, I think that’s safe to say. It really does take a community to build a successful business.
Tell me what have been your biggest challenges—both personally and professionally–in starting and growing Mingle Analytics.
The determination to do this from home and not relocate has been somewhat of a challenge. Earlier on I faced a lot more bias against us. A lot of people didn’t think it could be done from rural Maine. Some potential funding sources dried up after they found me unwilling to relocate, incredulous that we’d even try something like this from rural Maine. I have noticed those prejudices seem to be far less conspicuous the bigger I get, though. Nothing proves a point better than success.
So being rural created a unique challenge, at least in the early days?
It still does. When I opened this business I thought I’d last in South Paris for about a year, but I’d probably keep a home base here because I live in this community and it’s nice to have an office to work out of, but I assumed I’d relocate to Portland to tap into a bigger labor market and then from there go further south as I needed more people and different skills sets. When it came time to do that, when we were expanding beyond the labor we could hire locally, we carefully examined what were the expected dynamics and we greatly valued the time we spent face to face. It’s nice to have your staff together, it’s nice to brainstorm together, work together, build together, and we knew the moment we were in two different offices, we’d lose a lot of that. So as we thought about the dynamics, and also how we tap into a much larger labor force and grow as fast we expected to grow, we realized that it was going to be difficult to grow the business I wanted to grow in any single community, be that South Paris or Portland or even Boston. The likelihood might be better in Boston, although as I circulated it amongst my mentors through MCED what I was hearing is that you don’t cure the labor problem by moving to Boston. As people who were trying to recruit in the Boston area were pointing out, there were 10,000 unfilled technology jobs in the Boston area over the last couple years. So to relocate to an area like that wasn’t going to be a panacea. So we decided to embrace a remote working philosophy. We’re now dispersed. Three-quarters of us are in Maine, about a quarter local to Norway and Paris, another quarter are within commuting distance, a quarter are more distant but still in Maine, and a quarter are out of state.
That might end up being the most innovative thing we’re doing. Not the product we’re providing, which is innovative enough, but managing this remote workforce. We’re able to pick up talent wherever we need it in the nation, which has been great. My colleagues who are trying to build businesses in the Boston area aren’t doing nearly as well finding people as we are.
You mentioned an unprecedented opportunity to get market share. What’s the size of the market you’re going after?
It’s determined by Medicare providers. There are currently about 1.3 million providers that bill Medicare. Although an evolution of the program this year is cutting that in half temporarily, I expect within two or three years we’ll be back to 1.3 million potential provider clients. And that relates to 285,000 practices in the United States.
What’s the competitive landscape like?
We are, as I said, the second largest provider of this service in the nation, and really the number one has been the only real competition so far. We are neck and neck and only differing by a couple thousand providers perhaps in the number we serve per year. The next runner up is less than half of either of our volumes. The most recent data available is from the 2014 performance year. In April, we’ll see the numbers from the 2015 performance year. Although my assumption is we’ll still be number two, there is some evidence that we might actually take the number one spot. You might hear me from South Paris the day the numbers are released. I do expect to be number one ultimately, but I’m expecting it to take a couple years to get there. These guys have had a head start.
What are your larger goals for the business?
My goal is to be useful and build a better healthcare system and that’s how I measure my success. I know I need to be successful in business in order to do that. I think running a successful business, being number one, are means to the end, not the end in itself. And the end game is to improve the efficiency and effectiveness of healthcare. I want a product that my neighbors, my friends, my family, can access with far less hassle and more confidence than they do today.
Do you have any advice for people thinking of starting their own business, especially for people in rural Maine who might want to start their own business, but are held up by the fear that they can’t possibly do it from where they’re located?
I think having the courage of your convictions and not letting other people’s biases make your decisions for you. That’s one lesson. I’ve always been confident I could run it from right here and I don’t hear the word “no.” Second, it does take a community. There are some great resources out there. There are people willing to help and we all should be humble enough to accept that help. I think the challenge for every business owner or entrepreneur is to walk that tightrope to being open to ideas, criticism even, and alternative approaches, yet not just running from one to another. We have to critically try everything on for size. Someone says you can’t do that, you say, “Well, does that make sense?” And critically examine the idea and reject it if it’s garbage or accept it if it makes sense. The help is out there if you’re willing to do the work, take the risk, and do that critical appraisal of each piece of advice you get.