Thomas Fondren, CEO of Advanced Orthopedics of Oklahoma, walks through geographic, service line, and payer diversification at a 24-physician group, why his company went self-insured in January of 2026, and why he canceled a clinically effective bone health program that lost money. He also names the three AI categories worth touching now and the one thing that decides whether an 18-month project survives past month seven.
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He Picked the AI Categories Before the Vendors Could
It's a Process, Not an Event
Top takeaways
1. The gap between what patients want and what payers cover keeps widening
Thomas Fondren is direct about the pressure underneath everything else: patients want the newest robot, the best brace, the most technologically available equipment, but reimbursement is not moving with them. That gap is widening, and Advanced Orthopedics of Oklahoma manages it primarily through strategic payer relationships, not by absorbing the cost quietly.
2. Diversification runs on three angles at once, and none of them are a hobby
Geographic diversification (adding clinics, adding services inside existing ones), service line diversification (orthobiologics, eight physical therapy clinics across Northeast Oklahoma, an incoming rheumatologist with infusions), and payer diversification into the employer market, all running in parallel. Thomas's standard: when the group does something, it invests time, effort, and money into places that will produce a return, evaluated against an 18-shareholder strategic plan reviewed annually and checked quarterly.
Notably, cost and ROI are not the first questions asked. Who's going to do it and how comes first. Cost and return get evaluated at the back end, once the plan is set.
3. Going self-insured revealed exactly where the money was going
Advanced Orthopedics of Oklahoma went self-insured in January of 2026. The audit that followed was clarifying: pharmacy was the number one spend, and the group owns a retail pharmacy in its clinic. Orthopedics was number two, and the group has more surgeons than most groups its size. Both categories the practice already controlled.
That finding became the foundation for the employer strategy: direct contracts (including with Ascension St. John), specialized programs like labor-and-delivery physical therapy support for young mothers, and now four executive forums being organized for local executives and HR benefits leaders to talk through what's broken in healthcare and how the practice can help.
4. A clinically sound program still got canceled because the math didn't work
The group built out a bone health program with a well-trained PA and a real patient population that needed it. The drugs work, Thomas says plainly, that's not the issue. But drug cost versus drug reimbursement created a loss, and the hoped-for break-even, treated as a funnel toward future surgical patients, never materialized. They canceled it and redirected the effort into rheumatology, folding some of the osteoporosis work into that practice instead.
5. AI got scoped down before any vendor got evaluated
As an executive, Thomas gets roughly 20 AI pitch emails a day. Rather than assessing each one, he and the team narrowed the field to three or four categories they'd actually commit to: document management, prior authorization, and coding, all back-office work. On the front end, advertising and social media are being explored but the levers haven't been pulled yet. The categories were chosen before the vendors could choose them.
6. Board trust is what makes an 18-month project survive month seven
Asked for the single piece of advice that matters most, Thomas points to the exec team's relationship with the board and shareholders. Walking into a board meeting requires being able to say we want to do X, here's why, here's the cost, here's the return, and having that be believed. Physicians want instant gratification, but something like an infusion center takes 18 months from A to Z, and everyone in the room has to sign up for that timeline knowing it going in. His framing: it's a process, not an event.
Bonus: running the same playbook twice, a decade apart
Thomas ran executive forums for local employers once before, in Oklahoma City roughly in 2019. The first one drew four or five companies and felt like a near miss. By the fourth forum, they had to change venues to fit roughly 40 companies, and the focus had already widened past orthopedics into overall healthcare cost and mental health resources. He's applying the same lesson in Tulsa: start narrow, on MSK cost, then broaden into a fuller strategic conversation as trust builds.
Questions this episode answers
How should a specialty practice diversify its growth strategy?
Across multiple angles at once, not just one. Thomas Fondren, CEO of Advanced Orthopedics of Oklahoma, diversifies geographically (new clinics), by service line (orthobiologics, physical therapy clinics, an incoming rheumatology and infusion practice), and by payer (moving into the employer market). Each initiative is evaluated inside an annual strategic plan reviewed quarterly, with cost and ROI assessed at the back end rather than upfront, once the group has decided who will do the work and how.
What can a practice learn from going self-insured?
Exactly where its own healthcare spend is going. When Advanced Orthopedics of Oklahoma went self-insured in January 2026, the audit showed pharmacy was its largest spend category, followed by orthopedics, both services the practice already owns and operates. That insight shaped its employer strategy: direct contracts, specialized care programs, and executive forums positioning the practice as a lower-cost, better-outcome alternative for local employers managing their own healthcare spend.
Why would an orthopedic practice cancel a clinically effective program?
Because clinical effectiveness and financial sustainability are separate questions. Thomas Fondren's group built a bone health program with a well-trained PA treating a real patient need. The drugs worked. But drug cost versus reimbursement created a financial loss, and the hoped-for break-even, framed as a pipeline toward future surgical patients, never materialized. The program was canceled and the effort redirected into rheumatology instead.
How should a healthcare executive evaluate AI vendor pitches?
By deciding which categories matter before looking at any specific vendor. Thomas Fondren gets roughly 20 AI pitch emails a day as CEO of Advanced Orthopedics of Oklahoma. Instead of assessing each individually, he narrowed the field to three or four categories the group actually committed to: document management, prior authorization, and coding, all back-office functions. Front-end uses like advertising and social media are still being explored, not yet adopted.
What makes a physician-owned practice able to execute long, multi-year projects?
Trust between the executive team and the board or shareholders. Thomas Fondren points to this as the single factor that decides whether a project like an 18-month infusion center build survives past its early months. Walking into a board meeting has to include the cost and the expected return, and physicians, who Thomas says love instant gratification, have to accept up front that some initiatives are a process rather than an event.
Scale referral operations to drive growth and efficiency
Full transcript
Transcript
[00:00:00] And specialty healthcare growth is not optional, but scaling with operational excellence. That's the hard part. I'm Joe Zboch. This is Scaling Specialty Growth.
[00:00:08] Joe: Thanks for listening. Today's guest is Thomas Fondren, CEO of Advanced Orthopedics of Oklahoma, a physician-owned independent ortho practice in Tulsa with 24 physicians and more than 300 employees. Thomas has spent three-plus years as CEO, focused on what makes independence possible: strengthening governance, recruiting physicians, and scaling the business side to match the clinical side, all while keeping the practice fiercely independent.
[00:00:34] Joe: Thomas, welcome to the show.
[00:00:35] Thomas: Thank you.
[00:00:37] Joe: One of the things we talked about is this idea of being fiercely independent. And I think what goes hand in hand in a lot of the conversations I have is sustainable growth. I don't wanna give anything away about your market, since I'd appreciate your framing of it more than my own.
[00:00:54] Joe: But given where you are with the market forces, what does it look like to have aggressive growth goals and, from an operational standpoint, be lean enough, be mean enough, to have the excellence to support it?
[00:01:07] Thomas: Yeah, I think it's a balance you have to look at almost every day. The market is ever-changing, we all know that. We're kind of a medium-sized orthopedic group, and we're feeling the pressures just like everyone else. So you have to make educated decisions in your growth strategy versus taking care of patients every day.
[00:01:32] Thomas: And being independent like we are, we have to produce quality outcomes, and we have to be the best value. That doesn't necessarily mean we're the least expensive — we want to be the best value in the market.
[00:01:47] Joe: So what has changed on the patient side of things as it relates to expectations? A little later I wanna get into some of the things you can do to close that gap on the margin side.
[00:01:58] Thomas: The expectation, if you compare it directly to what reimbursements are currently doing, that gap is widening. Their costs are going up from a premium perspective. They want the best, most technologically available equipment. They want robots. They want the best brace. But sometimes the payer isn't for that. So the expectation between the patient and what we're allowed to offer, sometimes there's a gap, and we have to manage it — we try to do that through strategic payer relationships. But it is a gap that's widening, for sure.
[00:02:46] Joe: Over the three and a half years you've been at Advanced, tell me a little about doctor growth, clinic growth, and the new service lines, since how you think about orthopedics is evolving with the market.
[00:03:01] Thomas: Correct. So you look at diversification, and it's on all angles — it has to be. Geographic diversification, adding a clinic, or putting a different service in an existing clinic. From that it's service line diversification — we've added orthobiologics, we've added new physical therapy clinics, we have eight PT clinics now throughout Northeast Oklahoma. And then adding new service lines — we're in the process of bringing on a rheumatologist with infusions. We're also looking at payer diversification, more into the employer market.
[00:03:43] Thomas: So you have to diversify, and it needs to be calculated in nature. We're not in this to be a hobby. So when we do something, we try to do it right — invest time, effort, and money into the places that will have a return.
[00:04:03] Joe: You don't have a large feeder health system in the area. And I think one of the things health systems do — call it savvy, call it anti-compete, call it whatever you want — is snap up PCPs in the space to build their own closed referral network.
[00:04:23] Joe: You're doing an interesting thing that mirrors that in a lot of ways. I don't wanna say it's inspired by what health systems have done, but within this mindset of being fiercely independent, the geographic diversification, the service line diversification, the PT clinics — you're really building outward. Tell me about the conversations you're having with your team, with your physicians. What does it sound like in the room to map out a strategy where you're attracting folks from a wider array?
[00:04:55] Thomas: We have a strategic plan. We review it annually, and honestly about quarterly to make sure we're on track. That plan is pretty in-depth — we roll it out to the shareholders, we have 18 shareholders and a few employed physicians whose practices are still growing. Those shareholders are bought into the plan, and in the plan we first ask who's gonna do it and how are we gonna do it. Cost and ROI we don't put on the front end — we put that on the back end.
[00:05:31] Thomas: That gives us what we feel is a really good market strategy to move forward. From time to time opportunities pop up and we look at those too. Our strategy is pretty succinct — we understand it, we try to put our best foot forward when we roll something out, and the surgeons are kept in the loop on what we're doing and how. From the team's perspective it's really execution — do we have all the pieces of the puzzle in place, are the contracts signed, do we have the staff. It works well — not perfect by any stretch, but everyone's on the same page, and we all work really hard to get it done.
[00:06:28] Joe: To tee up some of the projects you're working on, I'm interested in what the patient volume share looks like today — where patients are coming from versus five or ten years from now.
[00:06:44] Thomas: That's a great question. As I look at it today, we're a very large sports medicine company — we cover about 25 high schools, four colleges, four or five club-level teams, and we can track referrals back into that world, not perfectly, but we have an idea. It's one of those situations where you can't rely on one thing, so we have to keep diversifying — build our own organic referral sources. Going into rheumatology, going into employer-based contracts, bundling contracts we can control, that's where I think the market is going.
[00:07:38] Thomas: The payers are going to be limiting access, it's just the way it is. My opinion is if a company has a smaller, more defined network and a real relationship with it, they're gonna have better outcomes. Our company itself just went self-insured in January of '26, and we worked very hard building our relationships into our network — the savings were substantial.
[00:08:11] Joe: Congratulations on going self-insured. From what I've learned and heard from peers, it's a big step, and it brings a really fresh perspective. The term value-based care has been thrown around for decades — when you go self-insured, I think it starts to make a lot more sense what that actually looks like, from a real, toothy standpoint.
[00:08:37] Joe: Within this employer-sponsored healthcare space, can you frame up your strategy? You're self-insured yourself now. There are VBC arrangements you could have with the Transcarents, the Carrum Healths, the Contigo Healths, Ready Rebounds of the world. Then there's direct-to-employer with actual contracts, and there's the workers' comp side. There's almost a naturally occurring harmony between how your practice operates and the efficiencies of other self-insured players who care about both outcome and cost, because they're on the hook for it. What does that process look like? I know you're doing employer education.
[00:09:18] Thomas: When we looked at it ourselves, we asked, we're fully insured, where is our money actually going, regardless of the premium? Our number one spend was pharmacy — we own a pharmacy, a retail pharmacy in our clinic. Number two was orthopedics — we own orthopedics, I've got more surgeons than most groups do. So it only made sense for us to go down this path. But you need a well-rounded network to do it.
[00:10:04] Thomas: We signed direct contracts with Ascension St. John — we have a good relationship with them for our employees. In physical therapy, we have a lot of young moms who need special care for their children, for labor and delivery, and we've set up programs for that. We've seen significant savings, and that's the thought behind going out to employers — we want to be the best value, have a relationship, create access for them. It's starting to gain momentum. We're actually setting up four executive forums for local execs and HR benefits employees to come discuss what's broken with healthcare and how we can help.
[00:10:58] Joe: Because healthcare is getting hard — it's not as cut and dry as it used to be.
[00:11:04] Joe: Tell me a little about dogfooding your own strategy. Now that you're self-insured, you had to put programs in place — education, behavior change, steerage, access. That's a whole level of business-to-business thinking, where traditionally the average practice markets to patients D2C.
[00:11:36] Thomas: As we roll out our employer program, some of it's bundled, some isn't. We work with the tribes here in Oklahoma, setting up specialty clinics where they can send patients at a certain time and we'll take care of them. Again, all it is, is creating access and diversifying how you manage your practice. You have to grow — practices have to grow, just like any business, you're either growing or shrinking. We're fortunate that we grow, our guys work hard and do things some practices just won't do, and we have the infrastructure for it.
[00:12:35] Joe: I'm sure there have been bumps along the way, where you've had to reset something — a different workflow, or the operational support behind a strategic growth initiative on the employer side. Any examples with the ops team?
[00:12:54] Thomas: We got into the bone health arena, like a lot of groups did. We had a PA well-trained in the subject, and obviously a lot of patients who needed it. It didn't fail, but it also didn't produce. We're not in this to be a hobby, and the reality is the drugs work — that's the hard part. But drug cost versus drug reimbursement created a loss. We were on multiple calls about it, thinking if we could just break even, we'd create a line of patients who might need surgery someday. It didn't work that way. So we ended up canceling it and went the other route, into rheumatology, folding some of that osteoporosis work into that practice.
[00:14:04] Joe: You're early on the employer side, with four executive forums coming up. Anything on the process or technology side you've done to prepare for these access and growth initiatives?
[00:14:18] Thomas: Like any group, we're working through the AI process. As an exec I get 20 emails a day about this AI or that AI. We've honed it down to three or four categories we've really jumped into. One is document management. Another is prior auth, trying to use some prior auth tools, and coding. So it's really back office things we're focused on with AI. If you take that to the front end, we're exploring a few things from an advertising or social media perspective that we hope will help. We haven't necessarily pulled those levers yet, but we're making progress.
[00:15:11] Joe: Can you tell me about a specific project coming up you're excited about? I don't know if it's the workers' comp side, you already told me about the employer side, but what's laid out in the strategic plan that would be useful for someone listening?
[00:15:26] Thomas: A couple of things. On the employer side, I spent 30 years in Oklahoma City, and we did the employer executive forums there. The first one felt like a bit of a failure — I thought, there's only four or five companies here, do they really understand what they want in healthcare? But by the fourth one, we had about 40 companies, had to change venues because it was getting too big. We didn't focus just on orthopedics at that point — we went into where their costs were going. Back then, around 2019, mental health was a big deal, and it still is, and there are a lot of resources around it.
[00:16:14] Thomas: So I think we have to diversify our executive forum here too — start with MSK cost and how we can help, but bring a well-rounded strategic initiative to them. The other thing we're working on is the infusion center — that's different for us, we've put a lot of time and effort and cost into it, built it out kind of like a med spa, so patients who come in have a great experience and want to come back and enjoy their time here.
[00:16:50] Joe: You've talked a lot about the clinical aspects of revenue diversification and expansion. Tell me about the organizational side — the people who need to be in place to support these things, contrasted with what a more traditional setup might have looked like 10 or 15 years ago.
[00:17:13] Thomas: The reality is, in today's world, you have to invest in people. Over three years, any executive change in an organization comes with some turnover, or reclassifying someone into a different role, and we've gone through that and continue to. But I think we're in a good spot — we have a really strong IT team we've leaned on, we've changed some things. Even in marketing and internal clinic operations, we're managing all these different pieces while making sure, since we like to say we're a patient-first company, that the patient has the best possible experience. We've had to make some hard decisions, and we're a better company because of it.
[00:18:13] Joe: What specific piece of advice would you give to a growth leader in a practice trying to get to your level?
[00:18:21] Thomas: I think the one thing that makes it all work is our exec team's relationship with the board and the shareholders. You have to build trust. You have to be able to go into a board meeting and say, we want to do X, and we think it works — here's why, here's the cost, here's the return. Physicians love instant gratification, but we know, with something like infusions, that's an 18-month process to get from A to Z essentially where we want to be. It's a process, not an event, is what I tell people. So physician relations — at the end of the day, healthcare still revolves around the physician, and you've got to have high-quality ones who love what they do, work really hard, and that usually creates great patient satisfaction.
[00:19:24] Joe: Thomas, thank you so much for your time and being on the show today.
[00:19:27] Thomas: All right. Thank you so much.
Hey, it's Joe. Thanks for listening. If you like what you hear, share with the peer, and if you're looking to scale referral operations to drive growth and efficiency, visit hatchcare.com.