Staying the Same Was the Bigger Risk: Why Pinnacle Care Chose a Partner

Michael Burcham: Welcome to Microcap Moments, a podcast from Shore Capital Partners that highlights the stories of founders, investors, and leaders who have taken on the challenge of transforming ideas and small companies into high-growth organizations. The journey of building and scaling a business takes one down many unexpected paths. 

It’s a journey where we learn from our mistakes, fall down often, but have the entrepreneurial grit to pick ourselves up and persevere. Within this series, we will share these stories of success and failure, of the challenges and the rewards faced by those who dare to dream big, and through their lessons learned, we hope to inspire others who are on a similar journey of becoming, growing, and leading. 

Anderson Williams: Dr. Brian McClain spent decades building a model of senior care that really works. So why would he look for a partner? Why change what’s already having such an impact? His answer: staying the same was the bigger risk. With an aging population and technology moving fast, a practice that improves, but slowly, is gonna get left behind. 

Before he said yes to a partnership, though, Dr. McClain asked to talk unscripted with chief clinical officers across the Shore Capital portfolio to better understand what it would be like. In this episode, I talk with Dr. McClain, founder of Pinnacle Care Providers, and Emily Rafferty, the CEO of the new platform, bringing Pinnacle together with Preferred Podiatry Group. 

They talk about what he heard in his conversations with chief clinical officers, how physicians keep leading the clinical model in the new platform, and why a reputation built locally over decades is worth protecting as the platform grows. 

Anderson Williams: Welcome, Emily. Will you just get us started and tell us who you are and what you do and where you do it, and then Dr. McClain, we’ll come to you. 

Emily Rafferty: Yes. Good morning. My name is Emily Rafferty, and I serve as the CEO of this new platform focused in the post-acute care space, which we have the privilege of building two brands, bringing them together, Pinnacle and PPG, and I have the honor of leading that organization. 

Anderson Williams: What about you, Dr. 

McClain? 

Dr. Brian McClain: Good morning. I’m Brian McClain. I’m an internal medicine and geriatrics physician and serve as the managing partner and founder for Pinnacle Care. 

Why Post-Acute Care Is Personal 

Anderson Williams: So Emily, tell us a little bit about your journey to Pinnacle. What did you do before? How did you arrive at this space? 

Emily Rafferty: Yeah. So it’s really a combination of my personal experience and passion, meeting professional experience and passion. 

I started in healthcare because of my experience with the healthcare system early on in life. My grandma was navigating, she had congestive heart failure. She was in the hospital. She was in her early 80s and was in and out of skilled nursing facilities, inpatient rehab. And even at an early age, I experienced the healthcare system and felt that there had to be a better way to experience the healthcare system, both as the patient and the family. 

Fast-forward, I built a career in healthcare and had the opportunity to lead organizations through hyper-growth, being at a point where there was a product that had a really good market fit But there was a need to scale it, and how do we do so in a way where we can do so more effectively, efficiently, build the account management infrastructure to really help grow and scale a product and build and develop a team, which is a, a passion of mine. 

And so over the past ten years, uh, really just wanted to take all that experience and bring it to an organization where they were at that critical stage of there is a really solid service, product, and it was ready for the next stage of growth, and how do we bring and arm the business? I was introduced to Shore via a former colleague, and he had had a really good experience. 

And so I got the opportunity to meet Shore. Uh, I never had interacted in the private equity space, but really just was enamored with the model and the individuals I’d met. And so when they called about this opportunity, it really hit home because over the past five to six years, I’ve been navigating the post-acute care space with my dad, and he also had congestive heart failure, and it’s been a very unsatisfying experience. 

It just didn’t feel like the care was being connected. It felt like he was regressing every time he was supposed to be progressing and making momentum. And, you know, for the last year of his life, he had transitioned into an independent living facility, and he passed away in February. Ultimately, congestive heart failure got the better of him. 

But when Shore called about this opportunity in, a couple months later, it really just hit home in terms of this is a chance for me to leverage all my professional experience but do so for an organization that is trying to solve this problem and make it better. And after meeting Brian and the team, felt like they were, and this is my opportunity to lead that. 

Anderson Williams: It’s that deep sort of personal sense of purpose that I think a lot of us have. But Dr. McClain, before we go further, will you just describe and define for anybody listening, so we all are working from the shared understanding, when we say post-acute care, what does that encompass first? And then just tell us why you chose to dedicate your career to this space. 

So just give us a clear understanding of what we mean by post-acute care and how you came to it. 

Dr. Brian McClain: Sure. So first of all, defining acute care means in-hospital care in medical speak, and post-acute means where you’re at after the hospital. So that would include an inpatient rehab unit, a skilled nursing facility, long-term care facility. 

Would it be a community of assisted living or independent living? That’s the space. And, you know, I, I came to this early. I actually was a nurse aide at a nursing home between high school and medical school and saw a lot that could use some improving. And then throughout medical school and residency found that it’s a pretty unorganized, fragmented care delivery that was happening. 

I would say there were many good people who wanted to do good things, but the specific medical and cognitive treatment really caused a loss of quality of life for people, and they were forgotten and overlooked many times. So we put together a model of care, and we started with, what would we want for our own loved ones? 

And we brought together some really engaged, talented docs, nurse practitioners, a support team, and armed them with the evidence-based care pathways, protocols, and unlocked some really strong quality outcomes. And that’s led to some unrealized joy to be present in those vulnerable folks. 

Anderson Williams: And when you think about that, when you say just from those early days, what did it look like to be unorganized in the sense that you’re describing? 

I think all of us at some point or another experience the healthcare system with a child or with an elder parent or with a grandparent, as you guys have described and you’ve experienced professionally, and we sort of don’t know what to expect. And you saw something clearly that you thought, “I would expect more for my family.” 

Can you put some more meat on that, just what you saw that you were dissatisfied with? 

Dr. Brian McClain: Sure. Absolutely. It was, and unfortunately, many times still is, operating in a crisis care mode, meaning when there’s a fire, then the care is we use a medical fire extinguisher, so to speak. The only way to really drive quality, though, and again, read quality as improved joy in living, is to be proactive and to be proactive and actually know the folks that are living in these areas well so that we can interact and manage a disease process that maybe causes a lot of loss in what you’re able to do. 

But being organized, we try and maximize what’s left, what can we capitalize on to improve your life? 

Anderson Williams: And Emily, what does that look like just from a business standpoint? What does your business model look like? Can you describe that a bit? 

Emily Rafferty: Sure. And just to build upon what Brian shared, it’s interesting to have experienced this model as a patient, as a family, but then to have, as I learned and had an opportunity to round with some of the clinicians at Pinnacle, to see it from the other end and realize that what you felt as a patient family is often driven by just the complexity of this space. 

And so while it felt like people didn’t care or weren’t trying hard enough, what I saw through the other end is it is just a very complex population to address because they are moving between facilities and because they are reliant on often family members being there, helping advocate for them. And when they’re not there, it’s really challenging. 

And so the business today is actually a bringing together two organizations. So Pinnacle really focused on primary care and psych, and PPG, Preferred Podiatry Group, focused on podiatry. And, you know, podiatry plays a big role in this population because often it’s an early indicator of sepsis or so for congestive heart failure or patients with diabetes, podiatry plays a big role in the care. 

And they brought a very scaled model. They’re in twenty-one states. Pinnacle has a really strong footprint and reputation in Ohio and a differentiated model. And so to be able to bring the power of those two organizations together and say, ‘Wow, this is our chance to really multiply the impact of what both are doing.’ 

And what is gonna be really… You know, the goal is if you think about reducing falls as one big outcome that we wanna impact, and we’ve got the podiatrists, we’ve got the primary care, we’ve got the psych, all which play a role in reducing falls. That to me is what the brand, what this combined organization is trying to do. 

And so when I had the opportunity to round with one of the physicians at Pinnacle, really just seeing the model is meeting the patient and their family where they are in that journey. And the experience in an assisted or independent living is very different than a skilled nursing, which is very different than an inpatient rehab facility. 

And just watching how the provider who’s partnered with a care coordinator really helping understand where did this patient come from, what are all the surrounding circumstances that led this patient here, who they’re sometimes… You know, they’re meeting for the first time, they don’t have this extensive history, and really trying to dig in and ensure that that patient is seen holistically and not just in that moment, that they’re really meeting and spending the time with the patient. 

And it was really powerful to watch the model in person. 

Anderson Williams: And Dr. McClain, when you think about, I mean, you ran your practice, built your practice over thirty years or so, and I just, you know, talking about where Pinnacle is today and partnering with PPG future partners on the horizon, what was it that you saw or you wanted as you think back to that goal of making a more seamless, more coordinated sort of experience? 

What did you see that made you start to think about moving beyond just your solo practice and thinking about a bigger partnership? Because that had to have been a huge decision. 

Dr. Brian McClain: Oh, it definitely was. And when you know that you have a model that’s proven to drive quality and make life better for folks, it really became, for all of us in the group, an urgency to make it, uh, available to as many vulnerable people as possible. 

And partnering with someone like Shore allows us to have scale, business know-how, systems that we did not have, certainly in the current advent of AI, with tying it to research and ability to pool information, and honestly, access to capital, and I’m not talking about just dollars, but the capital of talent. 

And Shore’s brought together some of the brightest minds in the country to help us think through how do we help more people. That was the driving force. 

Anderson Williams: Yeah. Did you have concerns? I mean, there are a lot of perspectives, and there’s a lot of different information out there about private equity, about– and certainly as a physician who’s led a practice and had that autonomy, did you have concerns? 

And if so, what were they, and how did you resolve them or get past them as you went through the process? 

Dr. Brian McClain: Sure. Absolutely. There, there were concerns staying the same or changing. So there wasn’t, like, a safe base that nothing’s gonna happen. Something’s gonna happen. What makes the most sense and what gives you the most power to help more people was really what that came down to. 

And then the level of trust that developed quickly by getting to know other chief clinical officers in the Shore ecosystem was very helpful. And when I say that, it was unscripted, meaning I had full access to ask any question, many times in person, several over the phone. Here’s the access to this person. 

Ask them anything you want. They’ve been with the portfolio for one to five years, and see what their experience was. And what that helped was at the base, it had to be mission-driven, continued for us with what we were trying to do and provide the care. And that’s what we’ve experienced, that it’s a hyper-focus on quality in a collaborative manner. 

Anderson Williams: Say more about your concerns in staying the same. You mentioned that there were concerns in changing and taking this kind of leap, but what were your concerns with staying the same? 

Dr. Brian McClain: Sure. So to get to the model that we’ve had, we had to have an attitude of constant improvement, and that’s really been a part of our DNA, that it’s never to the point that you can’t continue improving the model and improving the outcome. 

And we’ve gotten to where we are because of making those changes, some large, some small, on a consistent basis to continue driving forward. Staying the same or going at incremental pace with the population change that is in space and the information and technology that’s available now means we would’ve been left behind 

Anderson Williams: How do you think about, Emily, the evolution of the market as we think about technology, as we think about aging population and so forth? 

How did that play into your thinking about what you’re building over the next three to five years, just the shifts that are happening around the industry? 

Emily Rafferty: Yeah, and in some ways, ironically, the shifts that haven’t happened are what is fueling me and what I think is really our unique opportunity to make an impact in this business and take a model that, as Brian said, is the model we want for our loved ones, and figure out how do we multiply that impact so more people get access to this model and the care they deserve. 

And so I think that’s the opportunity that the industry really hasn’t solved in a scalable way. And so it’s not looking at how we think about– It’s not just the EMR, it’s looking at provider recruiting, retention. That is one of the hardest pieces that every founder we talk to struggles with. And so when I think about, well, what can we do as a platform to enable the clinical model to multiply the impact, it’s building a best-in-class way to attract and recruit and retain high-quality providers that are fueled by this mission. 

And that is something that, as Brian mentioned, it’s hard to do when you’re just trying to deliver the care. And so it’s not just about technology and scale, it’s about building some of those capabilities out to really ensure that we are serving the core of the business, which is our providers. And so not able just to find them, but we’re able to make this meaningful work and keep them inspired by this mission. 

So I think it’s talent acquisition and really thinking about serving the providers. I think it is technology enablement. There are many ways. I mean, AI can be a exciting word, a scary word, but it is an opportunity to better enable. And I know that a lot of the providers I’ve talked to are very anxious and excited about, how can this help me do what I want to do, which is deliver clinical care? 

And so if there’s ways for AI in a way that I haven’t heard from providers in the past, just to be ready to embrace technology, and this may make my life easier. So we are certainly very focused on that. And I think also just building relationships in the communities in a scaled way, because as we mentioned, patients are migrating often between these different parts of the community. 

And so how do we better connect and track and make sure that this care really is connected and that we’re playing our role in that? So that’s kind of, I think, some of the big problems to solve that we’re focused on. 

Anderson Williams: When you think about that, as I listen to you, you’re talking about capabilities, recruitment, technology enablement, sort of process and infrastructure kinds of things. 

You didn’t mention clinical models. You didn’t mention anything like that. And I have to believe anybody who is a physician or running a practice who’s listening to this and thinking, “Well, I mean, should that be a conversation I’m in or not?” Talk about your approach and your thinking, and then I’d love, Dr. 

McClain, for you to follow on as it relates to the clinical autonomy and those kinds of things that any physician would have a natural question, at least, if not a concern about. 

Emily Rafferty: I will start by, we are looking for partners that have the same connection to our why and what we’re doing, and that they have evidence of building a really strong clinical model, that they have driven outcomes, and that they are clinically led. 

So that is who we are trying to attract. And I think because of that, our job then is to allow that clinical model to flourish in the market it’s in, and we are helping enable and multiply the impact of that model. So, you know, I think as we’ve talked to different founders, and I’m sure Brian would say too, there is different ways in different markets and different ways that people are developing models to drive the outcomes to make it a better experience, but there’s an opportunity to learn from each other. 

And so, you know, what Brian and I are working on is a clinical advisory board. How do we allow providers to not just have a voice at the table, but to learn from each other to kind of build the momentum when you bring all these best practices that what worked in Ohio, you know, might work differently in, in Michigan or different states. 

And so I think it’s protecting the clinical model, but also allowing the clinical model to kind of build from each other, and that’s really the goal. 

Anderson Williams: How do you think about that, Dr. McClain? As you think about bringing on other doctors with similar or complementary models and how you support and protect and grow and learn from that, how do you think about that just from the physician perspective? 

Dr. Brian McClain: Sure. First of all, I think about it in an exciting manner. The ability to have other like-minded A players that are contributing makes a better outcome all day long. And really, everyone talks about and, and tries to do evidence-based medicine to get the best results. The trick always is: how do you operationalize that so that the whole team is able to help deliver that? 

And those are the parts working on together to continually make that better that really what we’re looking for is folks that have not just an appetite for that, but they live that. 

Anderson Williams: I think one of the things you mentioned earlier that I want to come back to is that in your own process, you talked with a number of chief medical officers across the Shore Capital portfolio who have, in some cases, years, in some cases, less time, more time with the model of private equity that Shore brings. 

And I suspect they all reinforced that Shore as an investor is, one, growth-oriented, and two, is focused on, just as, uh, Emily was describing, building infrastructure, process operations, but lets the doctors lead the doctors. So anything from those conversations that was helpful or reinforcing or questions that you remember wanting to make sure you got answered from another chief medical officer in the portfolio? 

Dr. Brian McClain: Absolutely. I can think of several. The basis is that Shore’s belief is that high-quality care is good business, and how do you get to the high-quality care they’re willing to invest in? There’s one portfolio company who was having a little bit of issue attracting folks and came up with the idea of setting up a mentorship program for new practitioners and physicians. 

That, by the way, has been very successful, but the launch of that required an investment of time and money, and they did it, and it’s worked. It would’ve been very difficult to do that as an individual practice 

Anderson Williams: Yeah, and that is, you mentioned it before, the access to talent when you’re growing, like the companies grow within a Shore Capital portfolio, is kind of a make or break. 

You can’t grow without getting, not just acquiring new talent, but bringing in those associate physicians and those younger career physicians. Emily, will you talk a little bit about growth and what the sort of horizon looks like for Pinnacle, where you’re going? 

Emily Rafferty: Sure. The goal is that, let’s say five years from now, that we have scaled across multiple markets, multiple states, and can look back and say there is quantifiable evidence that we have improved outcomes, that we have driven outcomes such as fall reductions, such as avoiding ED visits and hospital readmissions, and that there is undisputable evidence that we’ve done so. 

But we’ve done so in a way that has allowed providers to operate at top of license because we’ve built this engine in the background that has alleviated some of that burden. And so we have scaled revenue cycle management. We’ve built value-based care capabilities, which by the way, is the way to get rewarded for driving quality outcomes. 

And that when we look back, we’ve multiplied the impact of the patients and residents that have been able to access and benefit from our model. And I think most importantly too, that the communities to which we are providing these services in would look at us and say, “Wow, they’ve been a great partner. 

They showed up when they said they were gonna be here. They were reliable. They were consistent. They’ve helped us as an organization improve our quality and our star ratings.” And I think that to me is really the key, is because the way to access these patients is through the communities they’re living in and residing in, and we need to operate as a partner to them, and that to me is a, a really big focus for us. 

Anderson Williams: You’ve used a word a couple of times, and I wanna ask you, Dr. McClain, to help me understand it from your perspective, but you’ve used the word communities. You haven’t said practices, you haven’t said offices, you’ve said communities. And when you think about growing and scaling a practice, how do you still think in terms of communities as you think about growing this work? 

Dr. Brian McClain: Sure. Every place that we provide service has its own unique needs and challenges, and being able to be nimble to fit into those needs and deliver that care is what we would consider that specific community. And following on what Emily was talking about, which I’m full agreement, of the growth, what it looks like in five years, the impact we made. 

If we think about what does that look like in a community or take it even closer to the patient experience, what does that feel like? Your provider is able to spend time with you because of the process and technology that we’ve enabled that takes so much time so that they can get to know you as not just a disease process, but as an individual. 

And that allows proactive care. So instead of being treated in a more sterile hospital-type environment surrounded by people you don’t know, you can be treated in what’s your home with the warmth of people that you know, and that in itself has healing properties. 

Anderson Williams: How does that work? When you think about growing this business, I think a lot of people would assume that growth, and particularly with a private equity backed sponsor, that you would be thinking about efficiencies and less time with patients. 

And you just described the opportunity of spending more time with patients as a physician. How does that work in your mind, and how does that jive? And maybe, Emily, you can chime in as well, but how does that work together? ‘Cause I think that’s a little bit counterintuitive for what a lot of people would expect hearing from a private equity backed platform. 

Dr. Brian McClain: Sure. To drive quality from a patient outcome does take time, and to buy time, you have to strip out things that aren’t a value add. And what Emily was talking about with putting that growth inside and the internal capabilities help strip those pieces out so that you can convert that time into actually taking care of someone. 

That on the other side of it looks like someone who had proactive care, not reactive care, and then that does drive financial outcomes positively. 

Anderson Williams: How do you think about it as you think about talking to physicians, recruiting physicians? How does the platform you all are building help them do what Dr. 

McClain is describing, more of what they wanna be doing, which then is better for patients and so forth? 

Emily Rafferty: If you think about the logistics alone of serving this market, there are providers, physicians, our most valuable asset, driving often between facilities because you’re not spending– It’s not like a practice where you’re walking into a practice every single day and the patients are coming to you. 

We are going to the patients. And so just if you strip out all the other inefficiencies in the system, the drive time and logistics, if there is a way in which we can make sure that we are connecting where the providers are, what communities we’re serving them in, to the patient needs, and making that the most efficient for providers, that is an unlock in and of itself. 

And every founder I’ve talked to has struggled with, we are driving all over the state, and it’s really inefficient. And so that in and of itself means the more we can solve that, the more time providers are spending in buildings, which means they’re spending more time with the patients. And then there are probably the more obvious things that are common in the healthcare world of ensuring that the way notes are captured or the way visits are scheduled or how we communicate and integrate with between EMRs, with the communities and the EMRs they have and our EMR, all of that is also a big part of unlocking scale and efficiency. 

But I think that is the goal, right? Because the way we drive outcomes, to Brian’s point, is spending more time with the patients, and that is how we will grow as a business. 

Anderson Williams: Just to wrap up, I want to come back to sort of what this looks like. And Dr. McClain, when you think about that in your own experience and you think about the kind of patient journey, the patient experience that you want to scale, what does it look like in five years when you think about being able to really move the bar on long-term post-acute care and patient experience? 

What does that patient experience look like differently than it does when you look out into the market today? 

Dr. Brian McClain: Well, a couple of things. First of all, my goal vision for this is that we drive this, that we’re now the standard, ’cause that’s not present in market right now, and that looks like a patient that has very coordinated care, not disjointed from specialty to appointment to appointment to appointment, which is currently the situation. 

There’s a transport van or a family member constantly pulling up to the front of a community to take to yet another appointment. How do we coordinate that and bring it together that it’s a more seamless experience for the patient? And again, being cared for in your home setting is every time a better experience and outcome for the patients. 

That’s what it really needs to look like and feel like as we’re successful with this. 

Anderson Williams: So I’m gonna ask just one last question. What haven’t I asked that I should have? What haven’t we covered when you think about the market, when you think about your business and growth, when you think about physicians who may be listening to this conversation, what haven’t I asked that I should have? 

Emily Rafferty: I think there is a way to preserve the locality of the care that’s being delivered by various groups across states in that there are pockets of really great care happening. And I think to me, this is really just a privilege and a, just a unique opportunity to say, let’s help all these great pockets of care come together and fuel and really accelerate so that at the end of the day, we want this to be the model that our employee base would say, “This is where I would only send my loved one to be treated or to live in one of the communities that I know we serve.” 

And that- that’s what this is all about, and it is– I think it’s very personal to me, and it’s very personal to most people on our team. And so when we’ve gone around our management team and we’ve asked, “Why are you here? Why does this resonate?” Every single person has a story about an experience they had, and I think that’s what I want to leave with, that it is personal and the fact that so many people that story resonates with, to me, just screams opportunity and it’s time to do something about it. 

And there are a lot of groups out there trying, and we wanna find them and bring them together. 

Anderson Williams: If you enjoyed this episode, check out our other Microcap Moments episodes at shorecp.university/podcasts or anywhere you get your podcasts. Here you will also find our Bigger, Stronger, Faster and Everyday Heroes series, each highlighting the people and stories that make investing in the lower middle market unique. 

You will also find our latest video podcast series, Raw Talent. This podcast was produced by Shore Capital Partners with story and narration by Anderson Williams, editing by Reel Audiobooks, sound design, mixing and mastering by Mark Galup of Reel Audiobooks. 

Special thanks to Dr. Brian McClain and Emily Rafferty. This podcast is the property of Shore Capital Partners LLC. None of the content herein is investment advice, an offer of investment advisory services, nor a recommendation or offer relating to any security. See the terms of use page on the Shore Capital website for other important information