TUSK Practice Sales

Welcome to the TUSK Practice Sales Podcast, the premier podcast featuring the industry’s most influential thought leaders, providing the latest insights and trends for healthcare practice owners across the globe.

Kevin Cumbus

Hey. This is Kevin president, founder of TUSK Practice Sales. Welcome back to the podcast. We have spent so much time looking at financial statements over the last couple of months, and we’ve noticed a rather alarming trend, and that is the rising cost of marketing and advertising. And I understand it in healthcare, in specific verticals, in particular. And I’m thinking here of like, where you need to replace patients all the time, or you need to find new patients to work with. We see this in women’s health, optometry, behavioral health, women’s health, also med, spa, a little bit in dental if you’re thinking about oral surgery or implants. But there’s a ballooning expense on the income statement for marketing and advertising. And I think for you entrepreneurs out there, what you know is spending doesn’t solve it. Really what solves it is making sure that you have a system and a process in place to turn that phone call or that lead into an appointment, and that appointment into a patient actually showing up, and then you got to have them showing up and accept treatment. So, you know, there’s a lot of steps in the process, and as we were listening to entrepreneurs and their struggles, I said, ‘wait, there’s a solution here. So, I wanted to invite my friend Charlie Winn on. Charlie is the co-founder of Liine, that’s spelled L, I, I N, E, and really his technology is beautiful because it is super complex what he does on the back side of it but makes it pretty seamless for the users on the user end. It’s really an all-in-one lead management platform that automates new patient reach and tracking and follow up and follow through. Charlie, I am so happy to have you here. Thanks for making time to be on the podcast.

Charlie Winn

Thanks, Kevin. I’m really excited. Thank you for spelling the company name out, so everybody knows how it’s spelled. You know, when you’re trying to be a disruptive tech organization, you have to misspell a common word as your company name. So that’s why, that’s what we did. Line two I’s.

Kevin Cumbus

I love it. Give me the origin story. What’s the why behind this business? Why did you get started in this? And give us the origin story.

Charlie Winn

Yeah, the origin story is basically manually doing what our product does now. So, I was doing sales consulting, prior to Liine getting started. I mean, I think it was like early 2017 when we started. But basically, I got a contract with a behavioral health platform, private equity back. And you just mentioned this ballooning effect of the cost of marketing. And this group was aggressively advertising online. They had inpatient facilities for substance abuse patients, the mental health patients and so lots of inbound activity calls and forms and so forth. They leveraged Salesforce, the CRM platform, of course. And their idea was like, ‘hey, we’re going to track all this stuff so we know what’s working and what isn’t working, because we need to know that, because we’re spending all this money to make a decision.” The problem was, all of the communication coming in was handled by clinically trained folks that needed to be able to have the conversations necessary with those types of patients, or even the loved ones of people calling who were concerned about someone in their family. And so essentially, they didn’t use Salesforce. So, they had this platform. There was no good information in it. They couldn’t glean anything. Flying blind with this massive marketing budget. I mean, they were probably spending, you know, $50 to $60k in ads every month, and just didn’t really know what was coming from it. So, our consulting project was we manually listened to all of the conversations happening on the phone. We watched what the staff was doing in person as they followed up with people, and we built their reporting in Salesforce. And we were almost like their scribes, right? “Hey, this is how many new people came in today. Here’s what happened,” and so forth. So, for the first time ever, the leadership team had complete visibility into what was coming out of those marketing dollars. The staff didn’t have to do anything because we were doing it. And the results were absolutely fantastic. They had a predictable ROI machine because they had that missing data. So, that was the insight. How do we deliver that to lots of healthcare specialty practices, where we know this issue is going to be the same? But that was manual, right, we had people manually listening to everything. So, we started developing technology to do that in as automated a way as possible, while still maintaining the complete accuracy of the data, as if a person was listening to all this.

Kevin Cumbus

Out of curiosity, how many calls did you listen to personally? How many inbound calls Have you listened to over your career?

Charlie Winn

*Laugh* I should know that. I don’t know the amount of calls. It’s like over 10,000 hours in just like adding up the call length. But I remember when we first got started, we were still manually doing it, because we were trying to figure out, how do we build tech to replace myself and my co-founding partner. And I was, you know, I would do a lot of this on the weekends, listen to a lot of these calls. And my now wife, was like, Is this your job? She was like, “what kind of business is this man like, what?” Where are y’all headed? Because, I mean, we’d spend 12 to 14 hours on the weekend, right, listening to this stuff. So short answer is 10,000 hours plus. But I’ve heard some things. Kevin.

Kevin Cumbus

So, Malcolm Gladwell did the study right on these supposed overnight successes, and the Beatles are someone that they track. He does it for various stars and business owners who were seemingly overnight successes, and he mathematically determined that 10,000 hours was the appropriate amount of time before you become an expert and before you become dangerous to create a lot of value for folks. So, congratulations on cresting the 10,000-hour mark, you’ve done it!

Charlie Winn

I love it. I haven’t read that book in a long time, but I distinctly remember that, and hadn’t connected that until now. But yes, I guess that considers me an expert in that, which is great. I need to get something out of that time. Kevin.

Kevin Cumbus

So, with your experience with the private equity backed behavioral health platform. Really, private equity companies are into ringing in all inefficiencies in the business. So, you gained that experience with them. Now you’re bringing that knowledge, infrastructure, technology and platform to business owners that are not yet private equity backed. Walk me through that metamorphosis, how you went from the consulting opportunity to really building a business around this, and then helping the individual business owners?

Charlie Winn

Yeah, and part of it is just, you know, honestly, as we got started, you don’t have a ton of credibility and maybe context and so like, what can you get right? So, part of it is just the journey of getting started and getting more exposed to individual practices and working with those. We still do plenty of that right. We have a lot of our new opportunities come from marketing agencies who are also serving individual practices that are not part of a platform yet. And we help the agency, because the money that you’re talking about that’s being spent, that’s ballooning as a cost item is usually going to a third party, or at least some of it, a lot of it, third party agency. That agency is meeting with the practice every month, and that meeting is like, “Hey, what are we getting from this, right? All the time. So, we, with our technology, bring more clarity and deeper visibility into the outcomes of leads coming from marketing channels, again, without relying on any data entry from staff. So, a lot of our, you know, introduction into these practices is because of that. Now, initially, when we first got started, we didn’t understand everything about the healthcare marketer. What are the tools that they’re using? What are the things they’re trying to line up to ultimately get to ROI? And so forth. And it honestly was more of an operational and somewhat training platform to know how many leads are coming in. What’s the conversion rate? Why aren’t people booking? Why does Kevin have a higher conversion rate than Charlie? We still do all that for sure, but that was kind of more the core use case. As we’ve grown, and to answer your original question, that use case was more focused on the smaller individual practices, because they really cared about what the patient experience was. Not that the larger groups don’t as well, but they felt like they didn’t have resources to do training and stuff. So, we actually even offered training when we first got started, and then what we realized is that can be really impactful and work really well, but for us as a business, we started to focus more on the marketing. And the folks that are really investing in marketing are by the reason they’re doing that, is because they’re growing. So, it’s more often like multi-location groups that are expanding or maybe adding more providers, and then certainly platforms that may or may not be private equity back, and that is more of our target. You know, use case now is, how do you get better information about the outcome of your marketing campaign?

Kevin Cumbus

Awesome. So, you’re working with large private equity back groups across multiple industries, including, we’re looking at dental. We’re looking at med spa, dermatology, plastic surgery, behavioral health, ophthalmology, women’s health, you name it, right? It’s all over the place. I guess the overriding issue is, it’s hard to do this, right? If this were easy, nobody would need y’all. If it were easy to scale this, they would be doing it on their own. So, talk to me a little bit about the difficulty and the problem you’re solving and the levels of challenge that come along with it.

Charlie Winn

Yeah, yeah. I actually did a talk about this. I can’t remember where it was recently. But the talk was like three mistakes that practices are making with essentially their lead and conversion tracking. So, the first mistake, and sort of the first challenge, is aggregation of all lead communication. So, a lot of practices in the specialties we’re talking about, of course, people can call them, which is always going to be a big part of the equation. They can fill out, you know, request appointment forms, and then the practice is going to have to follow up with that person, outbound calls, text, whatever. And then now online booking is becoming more and more popular, which is not surprising at all, as an option for people to go ahead and schedule themselves. So, if you’re a marketing leader or a practice owner that obviously also cares about marketing ROI, you need to get all of that communication in one place. A lot of times, I’ll talk to folks, and just historically, they’ve only thought about leads as web forms, the people filling out contact forms, because those are the ones that they have some system of following up with. They don’t think about calls or online bookings as leads, which is kind of nuts, right? People are going to be choosing whatever method of communication they want. So, the first challenge is, you’ve got to get a call tracking type platform that can capture the marketing data where people came from before they call you. You’ve got to be able to export data from that system, get it out of your online booking system as well. And then the same thing with your web leads. Oftentimes those are three separate systems that practices are aggregating. That’s the first issue. Second issue is you got to de-duplicate that, because it is very common for a person to have multiple interactions across those types of interactions as well before they book. So, for instance, I can fill out a web form, and then you call me as I’m a lead, and I don’t answer the phone. You leave me a voicemail, and then I see that you have online booking, and I just book myself online. So now I’ve reached out, or I’ve touched you as a practice and a lead in three different ways, but I’m the same person, right? And so, if you have that system, then you’ve got to really track the phone number most likely to make sure that you’re looking at that on a people basis and not on an interaction basis. That sounds simple when I say it like that. It is not because you’re getting all these interactions from different things, right? So, if you don’t do those two things, then the data that you’re looking at to make decisions on marketing spend or changes in your process or staff training is going to be inaccurate. Now to what extent, it depends on how you’re doing it, right, but those two things are absolutely critical. They are doable, but they are very, very hard, and a lot of practices don’t have someone on their team that’s savvy enough with data and analytics to be able to try to take on something like that.

Kevin Cumbus

Well, it sounds like a forever Excel project with exports and downloads and removal of dupes. I can see some person. But I have to think about through the lens of TUSK, right? We’ve got folks texting us. We got folks calling us. We get them calling our cell phone. They’re calling the company line. We’re getting forms that come in. The inbound is all over the map, and to aggregate all that would be…it’s certainly a couple hours a day to try to get down to actionable data that we can turn into information. So, I think about it from a location perspective. That’s one issue. And then to scale that, my gosh. I mean, it becomes exponentially more challenging.

Charlie Winn

And even if you do it all, then what are the outputs, right? What are the visuals that show the people that are making decisions what they need to do really quickly? It’s an undertaking. Again, possible, possible. By the way, if you do all that, the third component of the three things I mentioned earlier is HIPAA. So, when you start exporting data and sharing it around and doing all this stuff like you now are putting it on yourself to make sure that you’re not sending something over email or using it in whatever messaging system, which most people are probably thinking about. You would be surprised, though, how often people will send me information over email. Practices where I’m just like, ‘don’t send that, right?’ So, you really don’t want, if you’re the practice owner or on the leadership team, as much as you can, you’d rather not have individual people in your organization exporting PHI and manipulating it. If you have to, it’s got to be really tight system, that’s another issue and a challenge with doing it manually.

Kevin Cumbus

So just to summarize, it’s aggregating the data. It’s the removal of the dupes and being mindful of the HIPAA compliance that comes with needing any type of patient information,

Charlie Winn

Those are the three right there.

Kevin Cumbus

Got it. You do that all electronically. Talk to me a little bit about the output and how it becomes an action.

Charlie Winn

Yeah, yeah. So, the plug of line is, ‘damn what we just said is hard, right?’ So, we do this for you, right? Your staff does nothing. There’s no data entry whatsoever. You’re not having to do the aggregation and the deduplication. That is what our system is doing. And then we are a HIPAA compliant platform, fully HIPAA compliant, so all the data in there is secure, encrypted, so on and so forth. We have a built in BAA in our terms of service. A lot of people ask about that. And then the outputs like, you know, this is built for healthcare specialty practices. So, the outputs of, ‘what do you see? How do you see it? What does it mean?’ It’s all built for the leaders and practices, because that’s what this is focused on. And the UI is such that you can quickly find an insight and then actually click into a chart, and the underlying communication or interactions for that will populate. So, for instance, let’s say I was talking to a practice last week, and they had a huge drop in their conversion rate, and it happened to be with Facebook ads, and it was location proximity. It was a group up in the Northeast, and basically, they didn’t have their geo targeting dialed in enough, which you have to be really mindful of in the Northeast, around like New York area, rather. Because if someone’s in this borough, they’re not going to go to that borough, even if it’s geographically close, right? So, you’re able to see why aren’t people booking by marketing channel? And then you just click into – these are the Facebook ads, the paid ads that aren’t booking because of location proximity. And immediately know that that’s a problem, and that’s an easy adjustment to make. So, it’s all done automatically. The UI services stuff for you, and you can click in and get to the heart of what’s happening. And then when you’re in that position, like you have the knowledge and the insight to make the right adjustment that will lead directly to more bookings.

Kevin Cumbus

I love it. So, you’re talking like we are. You’re talking with business owners all the time, and you’re hearing from them in real time, what successes they’re enjoying and what challenges they’re facing. Give me a sense of what you’re hearing today as big challenges. Knowing that you’re solving the conversion piece. But how? I mean, for example, the wages, the cost of team members is bananas today, across the board. What else are you hearing on the market in your conversations with healthcare practice owners?

Charlie Winn

Yeah, the first one that does pop into mind is staff. Part of its cost, part of it is finding good people and turnover. And, you know, the whole ‘people don’t want to work anymore, man!’ Yeah, and so, that is an issue. There’s also an issue of, even if you have people like enough folks to handle the intake, if you’re a multi-location group and growing or platform, multi-site, whatever, the disparate, fragmented teams that are all doing this initial job of handling the new patient leads, that is pretty challenging as well. So, then a lot of folks go, ‘oh, let’s do a call center,’ which makes sense, logically, but it’s really hard to do. There’s a lot of things I think that people don’t realize they’ve got to have in place. And folks are building call centers that like have never done that.

Kevin Cumbus

And I think call centers got really popular and I think folks got really excited about them, with the hopes that they could build a call center, they could get 100% control on all the inbound and the communication and the scripting, and they were hoping that they could save some dollars at the individual front desk at the practice level. Our experience in looking at the income statements of businesses with call centers is ‘yeah, they built the call center, but they didn’t gain any synergistic savings at the practice level, meaning no one was let go at the practice level, but we’ve added a call center, which comes with additional costs, and rent and business expenses, oh, and people, and the conversion rates haven’t changed. So, net, net, net, all we’ve really done is added a big slug of expenses that they’re begging us to get an ad back for when we take them to market. I think you’ve got to be in this for the long haul, meaning call it five to 10 years to get a return on investment on that call center. Because the other thing we hear Charlie is, ‘well, my call center can handle 3 times or 10 times the call volume.’ I’m like, ‘well, why is it overbuilt?’ Like, I think people like thinking that there’s silver bullets out there for these businesses, and there just isn’t.

Charlie Winn

You nailed it there. And admittedly, I’m not an expert at building a call center, so I don’t actually know the exact answers of, how do you get to that ROI faster? The people out there do, right? What I do know is, there’s a lot of people – It’s a sexy thing to think about – call center, centralized, boom, let’s go. And then someone is in charge who hasn’t done it. I see it all the time, and they end up in the situation that you’re talking about. I think one other thing that I would say is it’s maybe not a challenge that people realize, but when you become aware as a practice owner of an issue, you don’t have to become amazing at that thing immediately. There’s this phrase, I can’t remember where I learned this, but it’s called the ‘aggregation of marginal gains.’ So, as you start to look at your business, the full continuum of the patient journey. And you identify, ‘this is a problem.’ Certainly, there are some things that are such a big problem you have to fully solve them right there. But with what we help with the initial bridge between leads and appointments, your process, your team, they don’t have to become like a world class sales organization tomorrow to start making progress. And so, I find that a lot of these practices will make a massive adjustment when they realize something is a problem or an opportunity, and it ends up just putting them in another situation that is probably worse, as opposed to, ‘let’s take a step towards where we want to be, and then see where we’re at, at that point.’ So, I think that’s an issue that practices have once they’re identifying opportunities to get better.

Kevin Cumbus

Love it. I want to shift gears to you to talk about artificial intelligence. AI is something that we are focused on a lot here at TUSK. We are seeing AI become fixtures. The conversation topic of AI become fixtures at all the conferences we’re attending. I have to assume artificial intelligence plays a role in your business. Are we going to get to the point where we don’t need people answering the phones. How disruptive is AI going to be in, call it, lead management and turning leads into patients?

Charlie Winn

I was just on a compliance call this morning about this. So, you know, I think AI will more so be around, like, maybe some chat bots that are sort of like online booking type stuff. That’s going to be leveraged to help people schedule themselves and help themselves more and more often. I don’t think it’s going to take away from calling into practices and talking to someone. We were talking about specialty healthcare, right? So, if I might get LASIK, and I’ve never looked at it before, and I’m googling online, I’m like, well, okay, this could be like, $5,000 or $8,000 or whatever, and stigmatism, I don’t know what that means. I’m going to want talk to somebody, right? And a lot of people are still going to be that way because of the dollar amount that this stuff costs. So, I don’t see it taking away from the human experience, I just see it adding some more options, like online booking, chat bot stuff, and then the real use of AI in healthcare will be, how do we help people do their job more efficiently or better? Right? So, the marketer you know, is trying to get marketing ROI. Our AI is going to be able to help them get that without having to ask the staff to do another thing, which is, ‘hey, can you track my marketing insight stuff? I don’t have time to do that.’ And then they’re like, ‘Yeah, you’re right. Let’s go build a call center and yada yada yada.’ Right? So, we’re able to provide that information without adding an extra job as opposed to taking something away that I think is still going to, you know, that human to human touch will be there.

Kevin Cumbus

I think that’ll gives all of us humans, that gives me kind of a sigh of relief, right? It just could be a nightmare where were concerned that the AI takes away, rather than adds to. And I like your view a lot. I like the view of, ‘look AI’s going to give us the opportunity to create more value for you, create more data, information on which you can make decisions. But don’t think about it as it’s taking away.’ I agree with you. Healthcare is people business at the end of the day. And I want to know who my physician is. I want to know who my dentist is. I want to know who my therapist is, and I’m not going to be able to get there through some AI Chatbot. I’m just not. It feels like healthcare will likely be one of the great beneficiaries of AI from an additive perspective, while still maintaining that human connectivity that everyone so loves about the profession. This has been an awesome conversation. I really appreciate it. Is there anything I didn’t ask that I should have asked about scalability, what you’re seeing from your seat in this industry?

Charlie Winn

A lot of people ask about, and this is where you guys come in, is like, ‘when is the right time?’ And, you know, ‘should I do this?’ And I think one of the things that I’m seeing with the groups that are scaling the most effectively is the leadership team on the corporate side has a great understanding of the fears of a practice who decided that they wanted to sell to that entity, and the integration process of, you know, allowing the practice to be involved with the conversation and decision about different tools they’re using and things that they’re adopting at the pace that makes sense. That’s critical. The leaders on the corporate side certainly know what they’re doing with bringing in different technologies and processes, but having some level of empathy, of like, ‘hey, this is a new practice. They’ve been doing stuff a certain way for a certain amount of time.’ The groups that are scaling the best have that connection with the practice owners that are now a part of their family. And like, for us specifically, we don’t want a practice to just automatically have Liine just because now they’re a part of this platform. We want them to be involved with a conversation with us to understand what is this for? And how are we going to use it? In addition to how the platform is going to use it. And that’s just a much healthier way to leverage technology and new systems and so forth to grow the business. So, I’ve noticed that some are certainly better at that than others, and those are the ones that are really scaling nicely.

Kevin Cumbus

Yeah, that’s a good point. We get asked a lot, will business intelligence, AI tools, any technology, enhance my valuation? And the simple answer is, absolutely not. It will not. It is how you leverage that technology to the benefit of revenue and EBITDA that actually creates that. But paying for a subscription to any software provider creates zero value. It is how you use that tool in your business. And hearing about getting buy-in up and down the chain there, across the entire network, affiliated previously independent practice owners who are now affiliated with a DSO through an equity component. Yeah, they need to see the value in order to leverage all the good things that come from Liine or other software or business intelligence tools.

Charlie Winn

Totally.

Kevin Cumbus

Great point. If folks want to get a hold of you to learn more or someone on your team, how can they find you?

Charlie Winn

We’re really easy to find on LinkedIn. Our website is liine.com. You can submit a request, you know, call back there. And then my email is [email protected]. So, anyway you prefer, we’re omni channel, but feel free to reach out, and we’d be happy to help anybody listening that would want to learn a little bit more.

Kevin Cumbus

My guess is on the back end, you are aggregating all those from the web form to the LinkedIn, to the cell phone, to the email. Charlie, it’s really good to see you. I look forward to seeing you out on the road this year. Thanks for all you’re doing, for all these healthcare business owners. It’s mission critical, and I know it’s a big relief to folks who kind of see what they’re missing and start to mop up.

Charlie Winn

I really appreciate you having me on Kevin, thanks for the kind words. And likewise, we love what you do to help practices. And you know, there’s a lot of opportunity out there for everybody. With the saying, ‘the rising tide lifts all boats.’ So, we’re just happy to be a part of the solution and do whatever we can to help.

Kevin Cumbus

That’s awesome. Thanks, Charlie. Take care, man. Charlie shared a concept that I think is really, really important, which is the aggregation of marginal payments. Improving each system just a little bit, improving the hiring process, the onboarding process, or the software stack that you’re using and turning phone calls into appointments, and appointments into patients, and the patients into people who actually accept treatment and show up the next day to get the work done. So, this concept of marginal gains, little wins, I think, is really critical as you’re growing and scaling the business. And it’s also important to get it right early. And in the first one or two practices, use these as laboratories to test things. Start small, get it right, and then when you get it right at that point, scale it throughout your whole organization. Anyway, always good to get some time with Charlie. I’ll be seeing him on the road this year. And always great to have you all here. Thank you for joining us. Listen. If you got questions about what you heard, if you’re curious about what your business value could be in today’s ever-changing market, or you simply want us to provide you a valuation, give us the call. We’re happy to talk with you. It is a fast-moving market. Interest rates are changing. Appetites from buyers are changing. The buy side is vastly different today than it was even 30 short days ago, and it’ll be different by the time we publish this podcast. So, always love to give anyone a market read that we can. If you want to reach out to us, feel free to call us at 704-302-1043, or you can reach us on our website at TUSKPracticeSales.com. Thanks for joining us. We’ll see you next ti