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For this episode of E-Coffee with Experts, Dawood Bukhari interviewed Peter Cunningham, CEO of Evolve Healthcare Marketing, a data-driven healthcare marketing agency, located in Chicago, Illinois. Discover the intricate art of achieving measurable ROI, overcoming marketing missteps, and optimizing patient acquisition performance. Uncover the rising significance of online booking systems and proactive patient engagement strategies. Explore the ingenious approach to transforming negative reviews into opportunities for enhancement.
Watch the episode now!
The big challenge is identifying choke points in the patient sourcing and evaluation journey and alleviating them.
Hello everyone. Today we have with us Peter Cunningham, CEO of Evolve Healthcare Marketing. Evolve is a result-driven digital marketing agency focused exclusively on potential acquisition performance improvement for multi-site medical practices. Peter, welcome to the show. Thank you. Appreciate it. Peter tell us about your journey, and how you decided to start a healthcare marketing agency.
So originally this is my third business, but originally I had a corporate PR firm. So a lot of that was in private equity and real estate and then circled back to marketing and specifically set up a consulting practice to be an outsourced chief marketing officer for private and equity-backed healthcare businesses. And what happened over time, what began as a consulting business morphed in 2017 into a full-fledged digital agency specializing in patient acquisition.
How big is the team right now? We have about 20 people. It’s also impressive. You have served organizations across 17 different specialties. Can you discuss the challenges that arise when you’re marketing for, such diverse healthcare sectors?
Sure, so I would say it’s been an interesting couple of years. So I’m gonna answer that in two parts. The 1st is that COVID impacted the business of health care.
And 2 ways that have encompassed about 3 years, a period 1st, obviously shutdowns of elective and other procedure surgeries and elective procedures and that type of thing. But then what made it worse was the labor issues where they couldn’t hire people to answer the phones, clean the rooms, and do procedures, and that lasted longer than the shutdowns.
And so I would say in January this year, things started opening up again into the new normal, right? And it’s been a bit. Gangbusters since then. Now, with that said, I would say during that period, things shifted a bit and there’s been a lot of private equity in the space. Before COVID, it was about, there were sources, industry sources would say about 1.4 trillion private equity dollars were sloshing around in Sierra Leone. Consolidation of medical practices and that type of thing. Post-COVID, it’s over too, it’s almost two and a half trillion because a lot of monies that were maybe allocated for other industry sectors moved over to healthcare, which is deemed recession-proof.
So you’ve got a lot of money going in. And I would say between the money and the private equity dollars investment, the changes in the market dynamics with COVID, I’d say the hot areas behavioral health is huge. Treatment of anxiety, depression IOP programs, addiction programs, all those areas.
Pretty significant as well as specialty practices like allergy, ENT, orthopedic, and so on. Each has its different animal. There’s also a saying that medicine is local. Every market has a different, competitive landscape is very different in New York City Metro than it is in Des Moines, Iowa.
Yeah. Yeah. The cost of a click is very different. And so on. So the big thing to answer your question is, how do you customize? The campaign by service line by market relative to the competitive landscape. And that’s the needle that needs to be threaded.
I think also with a niche like this, you have regulations, but you also, there are so many regulations to take care of when you’re marketing for a particular practice also, like there are things where you have restrictions, you have certifications needed. And then you also have nuances to it. So as a marketing agency, or as a marketer working in healthcare, from an agency standpoint, what are the prerequisites? Like if somebody wants to look at healthcare as a niche, what are the things, that he or she should actually, keep into consideration before entering such a niche?
I would say a few things in terms of specific compliance issues with health care. There’s a general 1, which is the American disabilities act, which is beyond health care. So now, the American disabilities act does apply to websites. And unfortunately, basically what happened is. Someone who was legally blind sued Domino’s Pizza and won a lawsuit for 30 million since then, tens of thousands of lawsuits have been filed against organizations that have consumer-facing websites for lack of compliance and it’s pretty easy to fix with some widgets like accessibility, for example, to make a website compliant.
But then, on average, the settlements on these lawsuits are about 50, 000. I have a client, a newer client that settled 1 last year for quarter of a 1, 000, 000. And it’s pretty insane. So there’s that and a lot of medical practice websites as well as other industry websites are not compliant. Then there’s healthcare specific. So HIPAA compliance. So CMS, a government agency, issued on December 22, new guidance around HIPAA compliance as it relates to websites and data collection of websites, digital applications, like Google ads, Facebook ads, and so forth. And the short of it is it’s made things a good bit more stringent.
And the vast majority of medical practices are not compliant with, from a website or a digital marketing perspective given this new guidance. For a marketing agency to decide to move into this round they are going to need a point to educate themselves and create a point of view as well as a technology stack to execute for clients in a HIPAA-compliant way.
How do you differentiate yourself in this niche market? What is Evolve’s unique selling proposition?
So our unique proposition is measurable quantifiable ROI. Our goal is to create a predictable and profitable pipeline of new patients or new leads, if you will which is what every business owner or anyone running a business wants what we can do because of our specialization is we’re able to do a few things. We can look at what someone’s already doing if they’re doing digital marketing and how they compare to industry benchmarks as well as our benchmarks, which are typically three to four X that are the industry averages. And we can benchmark them. To see how well they’re doing or not. We can also see if they’re HIPAA compliant and all the different facets and so on.
And then the additional thing is because we can do that, we can develop performance to educate them on if they invest X. They should expect why in terms of the number of new leads and then based on other attributes, such as what’s the estimated value of a new patient? What’s their front desk conversion rate estimate or reality?
We can predict how much money they should be making. On average, our programs generate about a seven to 10 X return on investment in the first four months of a pilot program. So that’s what we do. That’s a little different.
I think like on average consistently maintaining that seven to 10 X, ROI is in itself very impressive. And, you have your processes and, the reporting formats you have for that. Like that speaks a lot.
Yeah. And I would also say meaningful reporting. So unfortunately a lot of the reporting with the practices that we talked to. For those who are looking to make a change 1 of the biggest complaints aside from not being able to articulate an ROI and their spend is actual meaningful reporting. It’s meaningful where they can clearly understand this is what was invested. This is what they got from it from a return on investment standpoint. And I think that a lot of agencies have reporting. Some have very little reporting.
This is troublesome, but then others do have reporting. But again, it’s a lot of vanity metrics, which, frankly, most of these clients, particularly in health care, don’t understand the relevance of it. In many cases, it’s not relevant. So that’s what we do and because we, I have a private equity background, a lot of our clients are private equity backed. There’s a higher expectation of analytics and reporting that’s meaningful, right?
What are the most common marketing mistakes medical practices make, when you talk to them, you do the discovery. What are the most common mistakes you feel they make?
Where do I begin? So as part of our process. In talking with someone, a potential new client will oftentimes do it, like I said, assessment of what they’re already doing. For example, we can break that into a bucket. On the website, what is the organic growth of that traffic? What’s the conversion rate of the website? So the goal, obviously, with the website is to get leads. Right, People call them and fill out a form on average medical practice websites have conversion rates of about 6 percent top performers around 21 percent or more. I’d say issue number 1 is having a poorly performing website. Those are leads you don’t have to pay for, number 2 on the digital campaigns- Not again, we have benchmarks on performance by specific specialties and so forth. I would say that there are a lot of campaigns out there that we’re seeing that these practices are doing that don’t have landing pages and are not structured properly from a technological standpoint to track conversions properly.
And there’s just frankly a lot of Poor-Performing campaigns because they’re not following best practices. And it’s typically a freelancer, They’re working with an agency. They’re working with that’s a generalist. That’s trying to make it happen there and failing.
Like when you talk about a medical, like you said, a medical website, a landing page is not being their website, not converting. I think also, content, like forms a major part of medical practice, because anybody who wants like medical advice, from a person, wants to research about who to go to and all of that stuff. So content becomes critical. So from an agency standpoint, I understand medical practices have in-house people who are writing content from an agency standpoint, like what is the best way to handle that which writers to hire do you hire specialists doing medical practice or, from a content standpoint, what is the best strategy from, like from an agency?
From an agency standpoint, Yeah. The answer is it depends. The truth is that, for medical practices, if you’re talking like a website, for example, you can do general information, but if you start getting into specific information on specific ailments. You need to have a writer who is a medical writer who understands the nuances and has that information validated by the clinician or one of the clinicians. The challenge that is things are constantly changing. If you go that route where yes, you have the main pages, you might have general information about, hey, who here’s who we are. This is what we do. This is how we’re different. But as soon as you go into the procedure-specific pages makes sense from a standpoint. It’s going to be ongoing work. You need to make sure that it’s clinically appropriate. And then it’s continuously being updated, so that can get a little pricey. But it also can be worth the investment because the deeper you get with those certain ailments, the more on-site SEO benefits that you’ll have.
How do you tackle the SEO versus SEM issue, when you’re planning a strategy?
Most of our clients in health care are not active marketers relative to other industries. They’re not typically extremely sophisticated marketers like in the SAS business or what have you or e-commerce and to a certain extent. In a lot of cases, we’re starting from zero. Or in a lot of cases, we’re starting behind zero because there are a lot of bad issues with the website with the basic stuff. So we have to go foundational. And so foundational is making sure that the website is technically sound.
So the technical SEO is sound. That the on-site SEO is sound from a foundational standpoint and then we jump into paid digital ads, which is the cash register. And so that, SEO is a longer-term proposition, the paid ads, that’s the cash register, right? They invest this, they’re going to get that in a fairly short period.
Once we are executing, we lay a strong foundation for everything. And because that website’s critical, making sure that sound is critical for the digital ads to perform. We execute the digital ads, and then we let that incremental revenue help fund the journey to enhance the website where we can start getting into expanding on-site as needed. On-site content, start getting into off-site SEO and those types of things.
Online booking, becomes so critical, for a medical practice, because that’s what you’re trying to do. You’re trying to, increase the patient acquisition. So what are the pros and cons a medical practice owner should know before purchasing an online booking service?
Like any suggestions, any good ones?
I’m going to answer this and take it in a slightly different direction. This also leads to mistakes that people make and practices make. The truth is that health care has gone retail and, people talk about consumer-driven health care today. That’s true. And. As part of that, in a world where people are using Amazon, for example, to buy a pair of shoes or groceries or whatever and have it delivered immediately, their expectations for engagement with a provider are much higher than they were even a couple of years ago. A couple of things with number 1, 1 mistake a lot of people make are actually on reviews. So that’s listing anyone, any medical provider that has less than 30 reviews or under 4 stars has a significant challenge. Who wants to go to an orthopedic surgeon? That’s has 3. 7 stars. Not many, right? So that’s a big mistake. And this gets into the patient engagement side.
Then when it comes to actual patient engagement they’re looking for an orthopedic surgeon, just making us up. They’re looking at different sites or Google My Business listings. Hey, look, they see, oh, they have favorable reviews. Let’s go to the website. Okay. These guys look like they specialize specifically in my ailment.
And then they looked at broken employment. The question is how quickly, and efficiently can they get in. Now, one of the challenges with big hospitals and health systems is there may oftentimes be this big bureaucracy you have to go through and a long waiting list. One of the benefits of an independent medical practice is that they typically have more flexibility to enter more nimble and can get them in quicker.
So that’s an advantage. Unfortunately, a lot of these practices haven’t fully capitalized on that. So when you call in to make an appointment, do you get right in to talk to someone or are you lost in a phone tree? Yeah, that’s a big issue. And then people just hang up because they’re frustrated.
Can they book online? For an appointment pick the day and the time and then book it. Bam, right there. I don’t know the exact figure, but it’s probably less than 10 percent of the medical practices have that ability. And there are a lot of different systems for being able to do this. Text message messaging, so 2 way texting again that’s something that would help people be able to book more appointments. Yeah, takes the friction out again, less than 5 percent of the folks out there have that capability. Now, who are the different vendors? There’s a million of them. There are a lot of different practice management systems and HR systems. They are broad-based across specialties, and that one’s specific by specialty.
They all have the pros and cons. There are no silver bullets. At the end of the day, it just comes down to what works best for that particular organization. It’s internal workflows and so forth to get the most juice out of the woman if that makes sense.
Yeah. Like you said a perfect line, like medical gone retail.
It makes it more important, not only to book appointments but then also to engage and retain your customers. So you need to have separate campaigns. Going on for that as well, as any particular strategy follows for that.
Oh, yeah. Again, it depends on the specialty and the location of the competitive landscape. But, there are a lot of ways of slicing and dicing it, but I will call out another big thing that these providers need to do. That’s also a. An occasional common mistake we recently had a pain practice as a client.
We launched their digital campaign performing well. We apply call attribution software, so we know and they know how many calls are coming in from where and so forth. But then when, as we were listening in a compliant way to these calls to the front desk. We found out that the front desk staff was turning people away because the 1st question was, hey, who referred you the old school way of doing things, particularly for that type of specialty is they would only take patients that were referred by a primary care doctor or another doctor.
The world’s changed the number. PCPs primary care providers out there shrinking big time and have been so trying to live by referrals only is a kiss of death. And ultimately what happened is we ended up exiting the relationship because although the CEO was all about consumer-driven health care, the doctors worked and they didn’t want to change their way of doing things in terms of getting patients from and the world just doesn’t work that way anymore. So I think they will have a really tough time in the next couple of years until they fix that. So the point is that we have to look at everything holistically. How do people source? Evaluate and choose specialty care, and there are different choke points in each of those steps. So the idea is to identify those choke points and try to alleviate them, whether it’s recalibrating or retraining yours. Internal staff who answer the phones are customer friendly and answer the phone with a smile on their face and do not care that they are self-referred embrace it to the phone system, not having a complicated phone tree that irritates people.
Established two-way text messaging and online scheduling capabilities on the website to have appropriate content to support their decision-making. And all those types of things. Again, we look at it more holistically. So it goes beyond. Digital marketing tactics go broader to that technology stack and operational effectiveness.
Peter, tell us your favorite client story.
My favorite client story that’s a great question. I would say, There’s a current client we have that’s a behavioral health practice that when we first began talking and essentially what they do is they have therapists to provide treatment for depression and anxiety, that type of thing, and they’re good size practice and 2 locations. And when we did an assessment, they were doing digital marketing previously.
He didn’t, he wasn’t getting the results he wanted. He just didn’t know why. And nor should ease. He’s a clinician. So when we assessed what was being done, a long story short is that they had a sub, I think it was like a complete 2 conversion rate on their PPC ads. And there were a variety of reasons for this. The goals were not set up properly in Google ads. The landing page was non-existent. They had the wrong phone numbers. Just a whole series of problems and net is a cost of a lead was costing them over nearly 1,800 dollars for the cost of a lead for a patient that, you know, 1, 500 dollars, not a good business case. So we went in, we did our proforma, and we started executing it. And today he’s down his cost of a lead. His lead system is predictable and profitable. His cost of a lead is under 50 and dropping further, probably get it down to 25 or 30. And he’s given demand for what they do. He’s been able to grow.
I think he’s added, almost 20, actually 20 new providers just this year, because because we’ve helped fix this process for him. And so he’s a happy camper and he’s and the great part of it is as an independent practice. They’re really good providers and they’ve earned the right to be independent, but there’s a lot of competition. And so we’re helping them solve that problem and they’re growing predictably and profitably, and I think it’s great, right?
Your advice to a medical practice, once, they get negative reviews or negative publicity, like how to handle that.
Sure. And I have a person on my team that’s one of the things that they do and counsel on. So I’ll try to speak high level. I know enough to be dangerous on that particular topic, but I would say that it’s having the right technology. It begins with having the right technology. For getting reviews, there’s Google reviews, which everyone knows, and this is the first thing people look at with, Google, my business listing, of course, and you want that over 30 reviews and 4 stars. So you want technology that can create some automated workflows so that you can proactively grow that number over time? Texting folks after a procedure, emailing them, have it all automated so that you can crank that number up big time. So that’s number one. Number two is it’s not just about Google. It’s also about health grades, vitals, and some other platforms where you put reviews specifically for healthcare reviews and providers. So having in that system to be able to do the same thing and allocate those reviews. Both clinical as well as Google, right? So I think that’s important. And then lastly, I think it’s, and they call it service recovery is having the ability to flag when someone is complaining online so that some, it’s a flagged and B can be addressed immediately in some cases, maybe it’s, Someone’s upset because of mistake with their bill through and health care being able to flag that and reach out and address the situation in many cases helps turn around the relationship, use the negative and create it, and make it an end to an opportunity to build a better relationship with that person and get them to come back. When you don’t jump on it, you don’t address it. You don’t resolve it. You just have an unhappy person who then, of course, as they say, marketing goes and tells 10 other people that they were unhappy with you, which is not good. So at a high level, that’s what I would recommend.
What are some challenges and opportunities you foresee in, healthcare in the next five years?
Challenges and opportunities. As I said earlier, I believe You know, breaking this down about 60 percent of our clients are private equity backed they’re doing, private equity firm buys a larger practice, a platform practice. They invest money into growing it organically as through as well as through additional acquisitions. That’s happening costs across specialties. That is going given the amount of dry powder out there, that just that’s going to continue over the next number of years. So there the pros and cons of that for the providers themselves. The pro is number 1 if you’re a really good provider, clinician, or physician, you’ve earned the right to be independent. And so there, this is a great time to be that. There are challenges in owning a private practice. But, there’s a lot of opportunity, so if they want to grow it and sell it to 1 of those private equity firms to cash out, they can do that in an unprecedented way today. The negative is if they want to continue to be independent, they have to compete with those folks who are doing the private equity deals. But in there, there’s also opportunities to on how to compete against them and so forth. So I think, again, there are a lot of pros and a lot of cons, but at the end of the day, if you want to be an independent provider, you’re a really good provider. You have earned the right to do that. There are lots of opportunities to differentiate yourself from the hospitals and health systems. And that’s getting easier and easier to do by the way as well as be able to build something up and get capital investment if and when you want to do it.
Peter, in the end, I like playing a quick rapid-fire round of three to five questions. Ready?
Perfect. Coffee or tea?
Ego is the enemy. Brian,
Your last Google search If you remember?
My last Google search, It was just the best steak house, in Chicago.
Nice. Peter, thank you so much for your time. It was fun chatting with you. Thank you for the insights. I had a good time.
Thank you. I appreciate it.
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