[ALISON PIDGEON]
You are listening to the Grow a Group Practice podcast. Whether you were thinking about starting a group practice or in the beginning stages, or want to learn how to scale up your already existing group practice, you are in the right place. I’m Alison Pidgeon, your host, a serial entrepreneur with four businesses, one of which is a large group practice that I started in 2015. Each week, I feature a guest or topic that is relevant to group practice owners. Let’s get started.
[ALISON]
Hello and welcome to the Grow a Group Practice podcast. I’m Alison Pidgeon, your host. I have had a lot of conversations recently with folks who have been listening to the podcast and it’s so great to hear their feedback and just hear what they’ve been enjoying, what they’ve been learning. And I wanted to ask if you had a minute, if you could rate and review us on iTunes or wherever you listen to podcasts. That way more of our colleagues can find out about the podcast and I would really appreciate it.

Today on the podcast I am interviewing Gabrielle Juliano-Villani. She is a licensed clinical social worker. She’s the owner and founder of Colorado In-Home Counseling, and she employs 14 therapists. She has a very unique model for her practice, which she will talk about. She also is involved in a few other things namely she’s a contributor and content creator for an app that’s called the GoodHeart Collaborative, which is focused on helping women in professions prevent burnout. She also has started a new business as a consultant for other therapists who want to learn how to bill Medicare which is amazing, because that’s such a needed service that can be such a confusing, daunting prospects, getting credentialed and billing Medicare. So she helps really demystify that process for therapists. She talks about that as well. So Gabrielle is doing all of the things and is doing some really cool work and I think this is definitely a must listen episode. So here is my interview with Gabrielle.
[ALISON]
Hi Gabrielle. Welcome to the podcast.
[GABRIELLE JULIANO-VILLANI]
Hi, good morning. Thanks for having me.
[ALISON]
I’m really glad you’re here. I thought we could start out with you introducing yourself and your practice to the audience.
[GABRIELLE]
Sure. So I’m Gabrielle Juliano.-Villani, I’m a licensed clinical social worker and I own Colorado In-Home Counseling and we are a group private practice in Colorado and we specialize, well pre-pandemic we specialized in doing home visits. We still do a little bit of that but we mostly work with chronic health conditions, the elderly, people who are disabled, dementia, caregiver, stress, grief, and loss. So that’s kind of my group practice and then I do a million other things besides that. I contribute to an app called the GoodHeart Collaborative, which focuses on tips to help with compassion, fatigue, and prevent burnout in helping professionals.

So I’ve kind of taken that and also expanded it a little bit. I also do kind of burnout coaching and presentations for agencies. And I also do consulting around Medicare because there’s a huge need for that too and that’s just kind of a weird specialty that we have. I’ve been working with Medicare for a long time, so I really understand it and want other people to understand it too.
[ALISON]
Wow. That’s great. So you kind of have your hand in different things, is that because you just are interested in lots of different things or is there another reason?
[GABRIELLE]
Yes, because I’m interested in those things and I think just talking about burnout, I was getting a little bit burnt out myself, trying to run a pretty big group practice. There’s 14 of us now and seeing clients and I just kind of fell into doing more consulting and training on the side and that just really kind of gets me going and I love it. So I’ve been focusing a little bit more on that. I do still see clients, but no more than usually 10 or 12 a week.
[ALISON]
Okay, great. So that’s a very interesting niche that you have for a few different reasons. One is, it sounds like you’re focused on more of a geriatric population, Medicare population, and then also that you were doing in-home therapy and I realize the pandemic changed that for you, but is there a reason that you got into that specialty or how did that come about?
[GABRIELLE]
So I actually worked for Humana for a few years before I started my private practice and I was an in-home care manager and I worked with their Medicare advantage population. So it was kind of similar to what my practice does now. I saw people in their homes and I kind of, I did more social work stuff, helped connect them to resources, was kind of like the go between them and their doctor, a lot of psychoeducation, some brief therapy. And of course, as these things happen, layoffs were coming and I was kind of thinking about my next steps and what I was going to do.

A colleague and a friend of mine in Humana, actually, she quit first and said she was opening a private practice and she was going to do the same thing, bill Medicare. I was like, “Well, I want to do that too.” So that’s just kind of how it happened organically because I love working with that population. I think a lot of times when people say home visits, they think of kids, but our Medicare peeps don’t often have access to transportation or they can’t drive anymore. They already have a lot of appointments. So there were a lot of barriers to them getting mental health services. So I wanted to kind of help bridge that gap, which has worked really well because it’s so specific that, and of course not a lot of people take Medicare. That’s really what helped us grow. There’s just a huge need there for that population.
[ALISON]
That’s great. That was one of the questions that I wanted to kind of dig into a little bit with you was, I know you said you have 14 staff people now, and so obviously, you’ve grown quite a bit and scaled up your practice. I know you’re probably going to get really close to hitting the million dollar mark this year, which is super exciting. So I think a lot of folks in our audience who might just be starting out kind of look at that and think like, oh my gosh, how did she do that?
[GABRIELLE]
I think about that too.
[ALISON]
So I guess I was wondering, obviously you can’t explain everything to us, but maybe just give us some of the highlights of what did you do or how did you kind of structure things to grow to that size? What do you think were the important things that you did or what were even some mistakes that you made? Because that’s something we can learn from as well.
[GABRIELLE]
Yes, mistakes are important too. I kind of did things I think a lot differently than other folks. I am very big on just relationship building. I love connecting with people and that is how I started to grow my practice. I made connections with other social workers and other therapists in the community. So that’s really important to me. I literally, in the beginning I would go into doctor’s office that I knew took Medicare and I would say, do you have a social worker here? Or who does your referrals? Can I talk to them? And I probably did that at like 30 places and maybe two or three I really connected with, but those two or three were amazing. They sent me so many clients and they sent me so many that soon I was seeing 35 clients a week, which was not sustainable and somebody, actually one of my Zumba students, I also teach Zumba as my self-care, she’s OT and she said, “I work with a social worker who’s looking for a job. You should hire somebody.”

I was like, I don’t know how to hire. That doesn’t seem like something that I should be doing. I don’t know any business stuff. I’m just a little social worker with my little private practice. But I interviewed this girl, her name’s Natalie, and she still works for me almost three years later, she was my first hire and it went really well. So I hired somebody else and that went really well. So as soon as they got full or close to being full, I would start looking for somebody else and that is just kind of how I things. So I didn’t even have a website until like the beginning of last year and that’s really helped of course, too, like very lucky to have a good friend who knows SEO very well and gave me a nice discount.

So she helped me a lot with that. So we get a lot of traffic from the website, but I still get most of my referrals from people in the community, other social workers, people in nursing facilities. So that has been how I really built my practice, was building those relationships with people. I think the mistakes that I’ve made along the way have been with hiring and not listening to my gut and my intuition. There’s been one or two times where I think I was just feeling kind of desperate, like I really needed to find somebody and I was like, well, this person is good enough, but there was something that was nagging at me there, and it ended up not working out. And I wish I would’ve just listened to myself from the beginning.

I think the other thing that I’ve learned about hiring just from more of a business perspective is that hiring part-time people just doesn’t work out very well for my business model and what we do. It just ends up not being worth it. So now I focus on hiring people who want to work full time. I only hire W2, as employees, so I want people who want to stay with me. I want to create good work life balance and make things very easy for them, they get benefits. So that’s kind of where I’ve been headed and it’s worked well.
[ALISON]
That’s great. So do you feel like, because you have W2 employees with benefits, do you feel like that has been helpful with recruiting therapists? Because it’s one thing to get clients, it’s a whole nother thing to hire a therapist and actually stay with you for the long term. So what do you thinks been the key to that?
[GABRIELLE]
So I think it has, especially I think for social workers, because that’s another key piece is because we take Medicare. I have to hire social workers or psychologists. I think that’s a whole different conversation. So, I have found though that a lot of them do want benefits. They want health insurance, so that’s something that I’ve noticed just in our field and just maybe in my community and where we’re from. Like I see like a lot of other disciplines that seem to be okay with a contract position. But I’ve noticed that at least for us social workers seem to want more of like benefits and more stability. So I think in the past it’s been helpful in recruiting people.

I think right now in this moment, it’s been very hard to hire. There’s a lot of different factors that I think are playing into that. People are knowing now that you don’t need an office, you can just do telehealth, there’s less overhead. There’s other companies like Saunder Mind and Headway that negotiate higher rates for you and do the billing. So I think that’s really attractive to a lot of people, but at the end of the day, if you’re doing that, you’re still running a business because you’re a contractor. So there’s also those things to take into account too, which I think maybe sometimes get a little bit more glazed over.
[ALISON]
Right, there is definitely those therapists that don’t want any parts of running a business and they just want to come and do their job and go home. So I think there will always be a place for group practices.
[GABRIELLE]
I think so too.
[ALISON]
Yes, for sure. So the other thing I was curious about as well is do you feel like, because you never had a physical office space because you were doing in-home therapy that allowed you to grow more quickly because you weren’t having to pay for the overhead of the office or were you able to kind of hire people maybe in different parts of the state or how do you think that influenced your growth?
[GABRIELLE]
I think it helped a lot too. It’s attractive first of all, to our clientele and our referral sources that we can just go to the client. But yes, I did not have that overhead. So that was really huge. We just use a virtual office, which is a location on my website and everything is like, I don’t know, a hundred dollars a month. So that’s been, that was really helpful, especially in the beginning when I was just getting started. And yes, I also was able to hire more quickly and expand more because we could cover such a bigger area. If we just had an office in Denver, then that just kind of limits us to people kind of in that but I was able to hire people in Castle Rock, all the way up to Boulder.

So if you know Colorado, or if you don’t, that’s a pretty big area and we even, I have somebody who lives in Evergreen, which is kind of a small mountain town. So we were able to serve those clients too. So that’s been really helpful. And then of course, just making more connections in those areas like, “Hey if you have any Medicare clients, you need help, I have somebody who lives in Castle Rock and they can go to all these different areas.” So we’re able to serve more people in a larger area.
[ALISON]
Great. That’s awesome. I wanted to switch gears a little bit and ask you about the consulting that you do around Medicare, because I feel like that’s such a needed service for people. So can you tell us a little bit about what you do with that?
[GABRIELLE]
Yes. So I love doing that, which is probably so weird for people to hear me say that but I love talking about Medicare because I think it’s very misunderstood and people are really afraid of it and because of silly laws that were made a long time ago. LPCs and MFTs can’t accept Medicare, so there’s a huge lack of providers who will accept it and even more who understand this population and want to work with them. So that’s kind of, another thing I’m passionate about is getting people more engaged in working with the older community. And I’ve done a couple trainings and again, I do one-on-one consulting also and I just go through the whole thing because it is complicated. It’s really complicated if you don’t understand it and it’s very overwhelming if you’re just getting started. So I just like to break it down for people and let them know it’s a lot easier than you think it is and you’ll get a lot of clients if you take Medicare. So yes, I love doing that.
[ALISON]
So what’s kind of the typical request that you get from, I’m assuming a therapist or a private practice owner. Like they come to you because they want to take Medicare and they need your help with setting it up or maybe they started taking it and they’re running into problems?
[GABRIELLE]
Both, I get both. So usually if I’m just getting somebody who’s kind of like interested and hasn’t started taking Medicare yet, then we’ll go from the beginning, I’ll explain the credentialing, what you need to do, how you do it, where you go. There’s one thing that’s kind of different, I guess, is that even though Medicare is national, they have different regions that manage Medicare in different states. So we kind of go over that and what that looks like. And then of course they get a lot of people who take Medicare and they maybe have one client and they’re already having issues. So from that standpoint, I’ll kind of do the same thing, like start from the beginning and explain these are the things you need to know. A lot of people don’t know that there’s a difference between regular Medicare and Medicare Advantage plans. So we talk about that. We will go through billing, I will help people step by step do their billing, which I think is really helpful. But yes, I want people to be successful and get paid, of course.
[ALISON]
Absolutely. That’s that’s excellent. So do you also help walk them through their credentialing process as well? Because I understand that can be quite complicated.
[GABRIELLE]
It can be complicated and it’s pretty daunting and overwhelming. So I do help walk people through it. I don’t do the credentialing for you. But I will take folks step by step. And if you break it down, it’s not as bad. It’s just very redundant. They ask the same questions over and over again, sometimes in different ways and it’s confusing.
[ALISON]
So what has been your perspective on taking Medicare? I mean, obviously it sounds like your proponent of it. So what are the advantages for the provider?
[GABRIELLE]
It pays pretty well. In most regions it pays well. It’s usually one of the highest payers and once you get everything set up, it is really easy to work with and to bill and they do crossover claims. So if someone has a supplemental plan that pays their co-pay, Medicare automatically sends it and then you just get a check for that copay, which is nice. So reimbursement is good. The clients have a low deductible, which is also really nice. There’s this like $200 a year, whereas mine personally is like $6,700 a year. So I’m a little bit jealous of that. Again, there is a lack of providers. So if you are a Medicare provider, it’s really easy to get clients. That’s another thing that I help with in consulting, how to market yourself. And the clients are great, so they’re all retired or disabled, so none of them are working so you can see people during the day. They usually stay around for a long time and they’re very rewarding to work with, just to hear those lifetime stories of everything that they’ve accomplished during their life.
[ALISON]
That’s great. Is there a separate website or a separate business you have for your Medicare consulting?
[GABRIELLE]
I do. So we have a Facebook group, it’s Medicare Consulting for Therapists and the website will be live at the end of this week. That’s also medicareconsultingfortherapists.com.
[ALISON]
Nice. I will definitely be referring people to you because I understand nothing about Medicare.
[GABRIELLE]
It’s a lot and it just kind of happened organically that I just understood it because I worked with these clients and I also worked for Humana and weirdly enough, my mom also sold Medicare Advantage plans for a long time and processed claims. So I just know a lot about insurance.
[ALISON]
That’s great because there’s like you said, there’s so many advantages to taking it and unfortunately they don’t make it easy to figure out the process, but once you do it’s great. So yes, I think that’s such a such a wonderful service to offer to therapists because it could make their whole business for them.
[GABRIELLE]
It really could.
[ALISON]
Yes. Very cool. Well, I want to wanted to ask you about the app that you were talking about being involved in, because that sounds like a really interesting project as well. Did you start the app or are you just helping with it or what is the structure there?
[GABRIELLE]
I did not start it. It was started by, her name is Kristen Harness and she used to run a nonprofit for human trafficking and she just got burned out. You can imagine doing that, and kind of her own other life experiences. So a friend of mine actually connected me with her because she noticed, I make like little silly to TikTok videos and IG reels and she was like, “You like making videos. You should talk to my friend, Kristen, who’s creating this app.” Because a lot of it is videos. So I connected with Kristen and now I’m just a content contributor and we do all kinds of things on the app to prevent burnout for helping professionals. So not just therapists and social workers, but we have attorneys and nurses on there too. So we’ve got all kinds of stuff.

We have mindfulness, I’ve done some guided meditations. I do a lot of CBT, kind of exercises and just explanations of how to prevent burnout. I also talk about preventing burnout and how burnout impacts chronic illness, because that’s another thing that I work with often in my private practice, chronic health conditions. So I talk a lot about that. It’s mostly videos that I’ve done and then we also have a forum so you can connect with other people too.
[ALISON]
Nice. So what kind of response do you get from the people who actually use the app?
[GABRIELLE]
It’s been really good. It’s been awesome actually just to see some of the comments. Like I did like a progressive muscle relaxation and somebody sent me an email and they were like, “You have no idea how much this helped me. I had such a long day.” So yes, people are loving it and it’s just really like small little tips that you can, any of us can do really to help prevent burnout.
[ALISON]
Yes, that’s awesome. And are people supposed to just like log in once per day and like do one of the videos or how are they actually supposed to use it?
[GABRIELLE]
There is a couple different ways. So every day there is a daily pep talk, which is exactly what it sounds like. It’s just a little pep talk to get you through. And then with that, there’s a mindful minute exercise that goes with it. And then there’s other things that are kind of in the archives that you can do anytime, so like any of those mindfulness exercises or the meditations. There’s also some longer ones. Like one of the ones I did was on chronic illness and those are called mentor sessions. So that just really talks more in depth and those are about 10 minutes long, just kind of like a little, I think say a therapy session, but like a mini little capsule of like here is how this can impact you and some things that you should know about it. So you can log in once a day and do, there’s like a daily gratitude journal also that’s really short. So I think even just logging in once a day can be helpful for people to do those little things. Or you can log in multiple times and maybe chat on the forum with somebody else who’s struggling, give them some support, get some support, those types of things.
[ALISON]
I love that because I feel like that just makes it so much, more accessible for people. And then too, like they might get exposed to some therapy things and then they might feel more comfortable actually seeking out therapy.
[GABRIELLE]
Yes, which we all love. We always want that.
[ALISON]
Yes, that’s really cool. So I’m really curious what is next for you? What are your goals for this coming year? I know we’re still three months or so away from the new year, but you seem like the kind of person who is a mover in a shaker. So I’m just curious what’s on your horizon.
[GABRIELLE]
I am. I want to continue to grow my group practice. So hopefully next year I would love to double what we did this year, get some more folks on board and be able to even have a greater reach with our clients. Eventually I want to expand to Florida because that’s where I live now. That’s something that’s going to take some time and some effort on my part. So I need to have the bandwidth to do that, but eventually I will. And then for me personally, I just really want to focus on doing more of my Medicare consulting, doing more trainings on chronic illness and burnout prevention.
[ALISON]
Awesome. That sounds exciting. So since you brought up the fact that you live in Florida now and your practice is in Colorado, can you tell us a little bit about what is it like to manage from afar?
[GABRIELLE]
Yes. So I think it’s probably a little bit different for me than people who had a brick and mortar. Although I think you could do that too, especially in the environment that we’re in now. But before, even when I lived in Colorado, we were still remote, my team was remote because everybody did home visits. So we would just meet up when we could and we would of course like talk and do our team meeting virtually. So we’ve kept doing that. We still have our team meeting every month on Zoom and we just do supervision and if we have to do any case consultations, we do that over Zoom too. Trying to just still keep everybody engaged is what I also try to focus on. So like we have a a Google Meets chat, we have a chat on the phone for group text thread. And then I go back to Denver like every two months, every other month or so and we get together then too. So I still want to be available and let them know that I’m still here, not just like on the beach, relaxing in Florida all day, although that sounds nice too.
[ALISON]
Nice. So it doesn’t sound that much different from maybe how it was when you were actually living in Colorado.
[GABRIELLE]
Yes, it’s really not. And I think even if we hadn’t been remote before, just if anybody else is ever considering doing that, I definitely think you can run your group practice from afar. Especially now we have Zoom, a lot of things you can still do remotely. Of course, I go in a simple practice and I check all their notes and their treatment plans. Like that’s all stuff you can really do from anywhere. I think it’s just making yourself still available to your team. So the time change sometimes can be hard. When it’s the end of the day there it’s already like 7:00, 7:30 here. So, and I’ll still answer the phone if somebody calls because that’s not fair to them. So those are things to take into account, but then I get to start work later because nobody’s awake when it’s 9:00 AM in Florida. So that gives me some some time in the morning to do some Zumba or get caught up on billing or whatever I need to do.
[ALISON]
Yes. Nice. Well, I know that, because you have a few different things going on, I wanted to give you the opportunity to tell us how people could get a hold of you if they want to check out your practice. You already told us the website address for your Medicare consulting, but if you could repeat that as well in case folks missed it, that would be great.
[GABRIELLE]
So for the Medicare consulting, we have a group on Facebook and I have done lots of lives and posted all kinds of stuff in there. That’s Medicare Consulting for Therapists. Then the website, which again is not live right now, but it will be soon is medicareconsultingfortherapists.com. Then for my group practice, we are at coloradocounselinginhome.com and all the information is on there too. If you’re interested in like the burnout prevention stuff or information on the app, all that is on there. And of course you can always email me at [email protected].
[ALISON]
Excellent. Well, it was so nice talking to you today, Gabrielle. Thank you so much.
[GABRIELLE]
Thank you for having me. I appreciate it.
[ALISON]
Thank you so much for listening to the podcast episode today. I hope you learned something new. I wanted to let you know about a project that I’m working on. I’m looking for practice owners who have achieved the level of grossing, at least a million dollars or more who want ongoing support, who want to talk to peers and colleagues who are in a similar place. I’m looking at creating a mastermind group for people who are in that phase because obviously there’s lots of support and lots of programs for people who are maybe just starting out or people who maybe want to try to scale up to a million dollars. But once you hit that million dollar mark, you’re obviously in a smaller group of people and you have a whole different set of challenges.

So if that is something that sounds interesting to you, please just email me at [email protected]. We can chat a little bit about what that’s like. Or if you know somebody who’s running a million dollar plus practice and you’ll just want to pass that message along, that would be great too. So thanks so much for listening and I’ll talk to you all later.

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This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. This is given with the understanding that neither the host, Practice of the Practice, or the guests are providing legal, mental health, or other professional information. If you need a professional, you should find one.