When Chris Nichols started Medical Management Options nearly 20 years ago, she had just three employees, two file cabinets and a shoestring budget. So tight were things that first year, the fledgling company couldn’t even afford to fix a water leak that threatened the ceiling.
“Every night before we went home, we’d have to go shut the water off outside so it wouldn’t ruin everything,” Nichols says. “And every morning, we’d have to turn it back on again.”
MMO has come a long way since then. The company, which provides mental health services, is one of the fastest-growing small businesses in the Capital Region as well as the country.
It ranks No. 86 in Business Report’s Top 100 private companies with $32.8 million in revenue last year, a 46% increase from 2008, when it reported $22.5 million in revenue. It also ranks No. 4,145 on Inc. magazine’s 5,000 fastest-growing companies.
MMO expects to rank even higher on Inc.’s 2010 list. Growth has been astounding: Revenues will top $40 million this year, an impressive 70% increase over 2008 and nearly five times more than in 2004, when CEO Rob Miller took over from Nichols, who is his mother.
The company has 16 outpatient and two inpatient treatment facilities throughout the state, as well as a transportation company, and more than 650 employees with an annual payroll that exceeds $18 million.
“I got us started and got us going,” says Nichols, an Alabama native with a deep Southern drawl and an infectious laugh. “But the real growth has occurred since I sold part of the business to my sons.”
Nichols founded MMO in 1992. She had a background as a substance-abuse counselor and worked for large national companies—first in Alabama, and then in south Florida—that provided mental health services.
Along the way, she learned the business from the inside out and ascended the corporate ladder from clinician to manager to administrator. In the early 1990s, a former colleague called and asked her to help run the Opelousas branch of his Baton Rouge-based company, Evangeline Psychiatric Care.
“I had a job offer in New York at the same time, and I had to choose between New York and Opelousas,” she says. “I chose Opelousas because I wanted to come back to the South. South Florida isn’t the South.”
Not long after, Nichols bought Evangeline Psychiatric Care and changed its name to MMO. Throughout the 1990s, the company grew steadily, but its rapid growth began when Miller took over and embarked on an aggressive acquisition strategy. That was about the same time the federal government drastically reduced its Medicare reimbursement rates to mental health care providers. From 2006-09, Medicare cut its rates by 32%, triggering a massive industry-wide consolidation.
MMO was in a position to capitalize, and started buying competitors and their treatment facilities around the state. Its revenues went from $8 million in 2004 to $32.8 million last year, and its employees increased from 200 to more than 650. As it has grown, so has its reputation and the number of private insurance companies that want to do business with the company. Currently, MMO’s patient mix is about 80% Medicare and 20% private insurance, but the ratio gradually is shifting.
“As we’ve become statewide, we’ve had more insurance plans want to utilize us now that we have a reputation for quality,” Miller says. “So we’ve been working with different providers to be their first choice when there are mental health issues with people on their plans.”
It’s increasingly easy for MMO to be that first choice. Not only does MMO provide a variety of treatment options, it even has its own transportation company that can help transport mentally ill patients to their facilities. Reliant Transportation was founded in 1997, and it has grown to the point that it runs the entire public transit system for St. Tammany Parish.
“You can have the best hospitals or services in the world, but if people can’t get to [those facilities], then it doesn’t matter,” Miller says. “So that’s why we started the transportation company, and now it’s sort of taken on a life of its own.”
The company owns and operates more than 100 vehicles—mostly buses—around the state. But it has also expanded to include a limousine and a trolley that do weddings, parties and airport transfers. It’s become something of a side venture, but it doesn’t detract from the company’s primary focus of transporting mentally ill patients, even if their facilities aren’t in the MMO chain.
Nichols and Miller make it a priority to direct patients to the clinic or hospital that can best serve them. To that end, the company employs community liaisons, who help people in times of crisis and direct them to the place where they can receive help.
“Sometimes that’s sending them to the state facility or to another provider,” Miller says. “We pride ourselves on that. If someone calls us, we’re going to find them the help they need, whatever the location or circumstances.”
The company also is involved in a lot of nonprofit and advocacy work to help mentally ill patients and the industry that treats them.
Nichols founded the Options Foundation, a 501[c]3 that provides housing for people with mental illness who aren’t ready to live independently or who need a place to transition after an intensive inpatient stay. She also founded the nonprofit Louisiana Association of Behavioral Health, a lobbying and advocacy group that Miller has taken to the national level. The organizations work to improve and preserve behavioral health care.
The endeavors speak to Nichols’ desire to improve the quality of life for people who suffer with debilitating mental illness. MMO bears the mark of her personality, which is to say it has a big heart. The company also is fiercely competitive.
“You cannot be on the management team if you don’t have a competitive soul,” she says. “We’re driven by being competitive. We’ve got to be good. We’ve got to be the best. We can’t stand to be beat.”
Miller has embraced that corporate culture. But as he looks to the immediate future, he believes the best way to be competitive is to rein in the growth for a year or two and concentrate on the quality of services. To that end, he wants to focus on measuring outcomes to enhance the effectiveness of treatments.
“That’s really important,” he says. “When people leave our system, we want to track their progress and really focus on the outcome of how these folks are doing. That’s our focus for the year: learning how we can better treat our patients.”
