E#34: Jared Aron on Patient Leakage, AI Receptionists, WhatsApp & Clinic Revenue

What if your clinic’s biggest growth problem is not a lack of new patients — but the patients you already paid to acquire, consulted, and then quietly lost?

In this episode of The Business of a Clinic, Sean and Jared Aron explore the hidden revenue leaks inside private healthcare clinics: failed consult progression, unrecovered cancellations, lapsed patients, weak lead follow-up, disconnected CRM/PMS data, and the temptation to “just put AI on it.”

Jared explains why cost-per-lead can be a misleading metric, why consult leakage is often more expensive than billing leakage, and why patient operations teams rarely scale at the same pace as patient volume. The conversation also looks at AI receptionists, WhatsApp at scale, human-supervised patient engagement, and why clinics need to treat retention as a revenue function — not an admin task.

This episode is especially relevant for clinic owners, operators, and healthcare leaders thinking about growth, patient recall, front-desk capacity, AI adoption, and how to build a more commercially resilient clinic.

In this episode:

• Why recovering lapsed patients can beat spending more on ads
• Why consult leakage is one of the most expensive problems in a clinic
• Why cost-per-lead does not tell the full story
• Why patient volume scales but patient operations teams do not
• The limits of AI receptionists in healthcare
• Why WhatsApp becomes a technology problem at scale
• How clinics confuse marketing communication with patient engagement
• Why patient recall needs ownership, data, and dedicated horsepower
• Why existing patients often re-enter the funnel as “new leads”
• Why CRM, PMS, and marketing data need to connect across the patient journey

Key idea:

The clinic growth problem is not just acquisition. It is what happens after a patient enters the journey — whether they book, attend, progress, return, pay, and stay connected to the clinic over time.

The Business of a Clinic is a podcast about the operational, commercial, and human realities of building better private healthcare clinics.

Hosted by Jared Aron, founder of Coherent.

Transcript

Sean 0:00

I'll ask you a bunch of questions, and you answer the quickest way possible. Just to test your familiarity with the problem space that Coherent solves. You ready? Spend on ads or recover lapsed patients?

Jared 0:15

Recover lapsed patients.

Sean 0:16

Why?

Jared 0:19

They know you there's no trust barrier they've already been there they have no questions, you know them, you know they're not gonna create problems for you

Sean 0:28

Good. Recover lapsed patients or hire more front desk?

Jared 0:32

Recover lapsed patients.

Sean 0:33

Hire more front desk or buy an AI receptionist?

Jared 0:36

Hire more front desk.

Sean 0:38

Hire more front desk or outsource to a call center?

Jared 0:41

Outsource to a call center.

Sean 0:43

Plug the consult leak or the billing leak?

Jared 0:46

Consult leak.

Sean 0:47

Reduce cancellations or fill the gaps when they happen?

Jared 0:51

Reduce cancellations.

Sean 0:53

Open a new location or fix the one you already have?

Jared 0:55

Fix the one you already have.

Sean 0:57

Add a new treatment or convert more of the inquiries you already got?

Jared 1:01

Convert more inquiries.

Sean 1:03

Train your team or give them better tools?

Jared 1:06

Give them better tools.

Sean 1:07

Reduce cancellations or fill the gaps when they happen, why did you choose what w- what you chose?

Jared 1:14

Cause if you redu- if you reduce cancellations, it's like prehab and rehab. If you reduce cancellations, you never have the leak to begin with. If the cancellation happens, you have a gap in your diary, then of course you wanna fill it. But the ideal approach is prevention. 'Cause if you prevent it from happening in the first place, then you don't have all the extra admin work around needing to backfill it, needing to reschedule, needing to consume front office time. If you focus on prevention around these key drop-off points, then you're much more likely to reduce the downstream headache of managing the calendar.

Sean 1:51

Interesting. And why, uh, you were saying, uh, consult leak versus billing leak, which one was...?

Jared 1:56

Yeah, I think it's just where you look in the stream. So, um, consultation drop-off is your most expensive thing that you can do. Uh, why is it the most expensive thing you can do? You've paid to acquire them. You've paid to put a practitioner in front of them. You've paid to let them use the room. You've paid front office time to manage their intake and access. You've paid a lot to get them from outside the clinic in through consultation. So now they've come through consultation, you've incurred all this cost. A lot of healthcare providers aren't even profitable at session one. They're either loss-making or break even. So take as an example, you spend £500 to acquire a new patient, you charge £300 in the first session, not to mention the cost of service, that's loss-making. So people think in healthcare that the marketing funnel runs to a consultation. It's not correct. Marketing funnel runs all the way through to a journey start, uptake. Cost per lead is a false positive. It's magical numbers. You can have a very low cost per lead, but as soon as you get into the actual consultation journey, that's where things really get dangerous And you need to be tracking all the way through. And one of the biggest issues here from a technical perspective is that your marketing often doesn't talk to your patient journey. And so you have a whole lot of lead flow. It drops off somewhere between becoming a lead and starting a journey, and you take a CPA, cost per acquisition, that's completely off the mark because you've totally misestimated what the actual cost is. So the only way to cost the true cost of starting a journey with a patient is you take all the marketing spend, everything in every corner of the business, take all the marketing spend, and you divide that by the total number of new starters in a given month. Not new consultations, new starters, all the way through to the journey. That is what it costs you to get someone onto a pathway in clinic.

Sean 3:48

You had a call just now earlier with a potential customer, and they were spending close to a million a year on marketing. I was listening to the call, and it sounds like they resonate with everything that you were saying in terms of patient leakage, um, stopping patient leakage across the entire journey. What was the number one problem or pain that they were experiencing?

Jared 4:12

Yeah, it's a good, it's a good question. So when we think about our clinic audience, there are different levels of awareness, and this is often what we're looking for in a first sales conversation with a clinic. Do you know the problem exists? Do you not know the problem exists? Do you know the problem exists and you think you've solved it? Have you actually solved it? So all of these are different qualifiers, and so what was really interesting about this conversation is that the clinic was very aware of the fact that they had an issue, was very interested in doing something about it, and was aware of the fact that their current setup, their current client care team, their current patient care team, is very, very focused on new lead flow and not necessarily attending to the different stages of the journey where these patients are dropping off. And so they are problem aware and interested in addressing it. Now the question is why? And what I love about this clinic owner is he said, "It's revenue That is the indication of a growth mindset in the practice. How am I going to move the needle on top line and to do that cost effectively? And the calculation that he's doing in, in his head, of course, is, well, if I'm gonna pay these people to help me deliver this outcome, am I gonna see more than that coming back in? Of course, the answer for us i- is yes, 'cause we're tracking to a, a positive outcome. But he is very clear in his mind that retention along the journey, this idea of drop-off, of leakage, it is a revenue problem. That is it. It is not a who does it problem, it is not a systems problem, it is not a tools problem. It's a revenue problem. And as soon as it becomes a revenue problem, it becomes the only problem we're solving. And this is something that we try and reinforce with our practices. It's great to, uh, to think about the different micro adjustments, the 10% improvements that you can make in the clinic to make things a little bit faster. Very few of those 10% improvements have revenue line impact. Obviously, it needs to be revenue that doesn't cost more, but this obviously isn't the case here. So the question is, is this thing a revenue priority? And we said to him on the call, "You've got 100 priorities as a clinic owner. Where is this on the list?" And what he said, which I think was great, is, "Well, it's a re- it's a revenue problem, isn't it? So pretty high up." And I think that's a reflection of someone who's in the mindset of growth and not in the mindset of, "Oh yeah, I should be following up with people a bit more." This is someone who's trying to grow, and that growth is very much, A, the right fit for us, and B, indicative of a, of a clinician or a clinical leader who is also, by virtue of how they're thinking about their business, very entrepreneurial. And that sort of entrepreneur clinician is a rare breed, uh, but it's a very exciting one.

Sean 6:55

And essentially, the, the solution now we offer, well, the, essentially the solution that Coherent offers to, uh, the customers were a, an operation one, but it solves a revenue problem. So essentially, operation is the problem for revenue, right? And why do you think, especially for the mid, mid-side sized, uh, clinics across dentistry, um, MSK and, um, aesthetics, why do you think... I'm deliberately, uh, um, sta- sta- um, talking about more than 20 people, 30 people size of clin- clinics. Why do you think that's a problem, that operation creates the revenue problem? Yeah.

Jared 7:41

So this is a... And I, I remember when I was

Sean 7:44

starting- And actually, before, before you start, uh, why do you think the clinic owners or the operators M- missing that important piece of the puzzle

Jared 7:56

Yeah Yeah Yeah. So, so, um, I remember when, uh, when I was starting in, in clinic operations, um, and I spoke with a very fast-growing group in the US. Um, I think they were in 80 or 90 sites in, in medical aesthetic space. And the number one piece of advice that this person gave me, this was the, the COO at this group, uh, she said, "You always must remember that patient volume scales, patient operations team does not." So you have an ever-growing patient body, new patients, inflow patients, legacy patients, but even though the patient volume grows, the patient operations team doesn't. You don't hire 10 times the number of patient coordinators when you have 10 times the number of patients, because you have a finite number of patients you could see at any one point in time. And so the patient operations function for most healthcare providers is dedicated to serving the inflow patients, the people who are on track, not the people who are off track. And so you have this massive gap, which is I'm really good at focusing on the patient in front of me, and I have absolutely no way of even knowing, identifying the patients who aren't. And you really have to think about this as a technology problem. This is not a recruiting problem. So I'll give you a very simple example, WhatsApp. WhatsApp is a very, very high engagement channel, phenomenally engaging channel. We see WhatsApp as the leading place to reach patients, particularly in a younger demographic. Maybe not so much if you're an MSK, you have an older patient body, but if you're in a younger demography, WhatsApp in UK and Europe is the dominant communication channel. But using WhatsApp at scale is a technology problem. Not using a one, a one-site business WhatsApp that allows you to correspond with a few patients. That is not the problem of using WhatsApp at scale. Managing rate limits, sender status, ensuring that you can reach and respond to patients at scale. What will you do as a healthcare provider if you reach out to 1,000 patients on WhatsApp and 900 of them write back into you at the same time? How do you handle that? You don't suddenly have someone who's able to move through that volume. Even if you did, if all of those people write back in, in one instance, triaging, managing, prioritizing the urgency from less urgent, that is a technology problem. It's not a people problem. And so what we find in healthcare provider operations is that they build their team to focus on the one-way patient journey, new to end. They don't build the team, and they don't build the technology, and the existing technology, practice management software, EHR, is very much focused on the inflow patients. And then they bolt on the extras. "Oh, you haven't been in for three months. We can send an automated email. Oh, you haven't been in for six months. We can send an automated text message." That is not an efficient patient engagement communication solution. That is a, an afterthought because everybody knows it's an important feature, but not necessarily one that people are investing fully in. I'll give you a different example. We were speaking with one of our customers today, very, very fast-growing group, two sites, really high footfall, grow- going into third site now. And their practice management software, who will remain unnamed, recently released an AI patient coordinator, AI receptionist, and we were very interested to hear how that had gone because they were rolling it out, and the clinic owner said in no uncertain terms, "It's absolutely not AI." She was convinced it was not AI. I said, "What, what do you mean?" She said, "Well, it's always wrong." So it's great

Sean 11:44

that- Could that be a sign that it is AI?

Jared 11:47

It could be a sign that it is AI. But I think her expectation, her expectation was that AI would suddenly create this massive capacity uplift, and the honest answer is that we're not there yet. You know, everyone says, "Put an AI receptionist on it," and there's this great, this great quote that came out from an investing partner at a very, very successful firm in the US, venture capital firm, who said, "You know, everybody wants to roll out AI for dentists until they actually try and do it." And that is the reality of healthcare communication and engagement. It is not Push button, magic happens. This is not a standard consistent workflow. People write in with weird things. They write in at weird times. And if you're selling a 3,000 pound treatment, you want empathy at the patient interface. You want something that feels human, that can understand, that can work with the patient to overcome objections to purchase. That is a very, very high considered purchase. There are not many things that an individual will spend 3,000 pounds on in a given point in time. So the idea that you can put an AI agent in, in front of a patient for a 3,000 pound purchase and also to handle your e-commerce shoes return that you spend 50 pounds on are very, very different things. And so there's a category error there that really needs to be unpicked at the clinic operator level.

Sean 13:00

Uh, fundamentally, you don't believe, um, pure AI receptionists or solutions can solve the healthcare problem-- healthcare operation problem. Was it because of, uh, the fundamental premise of AI, uh, right now is a complete hands-off software, uh, tool set that is not supervised by External, internal human beings, and the expectation was it does the job that currently the human being on the team are delivering

Jared 13:29

So I, I think if you look back at innovation through, through time, so I think Tesla is a great example. So what was the first Te- the Roadster, I think was the very first Tesla model that came out. So the, the, the Roadster, whatever the first model was, I think it was the Roadster, they were not in any way unclear about what that car could and could not do. They said it's gonna go zero to 60 in this time. You're only gonna be able to drive this far. They set the expectation, but they delivered a great experience. People who bought the Roadster, they knew they were not doing long distance driving in the Roadster. There was no mismanagement of expectation. They said, "You're getting this because you believe in the vision, you wanna be an early adopter, you think there's something special here, you're gonna be early on the electric vehicle train." They made that very clear, and then the Roadster got better, and it got better, and the duration and the range got better, and it got better. We are very early in that cycle right now, and so the idea that Tesla rolled out the Roadster and promised people f- like self-driving is, is not how it happened. It happened over a decade, if not more. And so right now, a lot of what we're seeing in, in technology, AI implementation in healthcare is it's promising self-driving, but it's delivering a Roadster. And so you need to be really, really hands-on, and that, that totally defeats the promise because if you're saving five minutes not answering a call at 9:00 PM, but you're spending twenty-five minutes undoing the work of the thing that was handled incorrectly, that is loss-making on time. And I think often what we would encourage, and certainly what we say, is the reason we go end to end, the reason we provide technology-based solution with a human overlay, is because you get to be hands-off. But we can't deliver hands-off with a technology-only solution, at least not right now. We have to be hands-on, but we want to be hands-on so that you don't have to worry about it. That's the difference between AI only, where someone has to be hands-on, and something that's delivering fully self-driving. It's just not possible right now, so I think the promise and the delivery is just not there. Where we have seen AI really move the needle is in very discreet workflows with really clean data and someone sitting there watching it, monitoring it, making sure that performance is reliable. We're just not there, and we have mystery shopped a lot of clinics. That's part of what we do here. We constantly reach out to clinics. Whenever we see a clinic has implemented a new AI reception tool, they often shout about it, "So excited about our new AI receptionist." We call them right away, and we keep calling. We say, "How many times do we have to call, and how off the script do we need to go before things really start to melt down?" And sometimes it's handled really well. Sometimes you get all the way through, you're booked in, and wow, it really saved you time. But on the other side, let's say you're a new inquiry and you don't want to go through with this anymore because they've asked you the same question three times. Are you factoring in that cost to your provision of that AI receptionist? So you're spending £1,000 a month, £2,000 a month, but what about the five leads that you just lost? That's £5,000 of value that's not making its way into the clinic. So when you assess a, a tool, you need to select and you need to assess at the P&L level, not at the time level. Time is impossible to measure. There's that great study from Ambient Listening, the AI medical scribes. It saves practitioners X minutes per, uh, per visit. Fantastic. And then there's another study done from administrators that says it costs administrators an extra however long because now they have to go audit all of these different layers. So there's always a trade-off. The question is how are you assessing that trade-off?

Sean 17:10

Funnily enough, I was trying to book an appointment with

Jared 17:13

a prospect-

Sean 17:14

and it was a very promising-

Jared 17:16

Yeah,

Sean 17:16

yeah uh, prospect, and they're doing quite well. It's a great dental group.

Jared 17:20

Yeah.

Sean 17:20

Um, and they, they in- the clinical experience is excellent. Uh-huh. Um, the... Even the receptionist, the, the entire experience with the receptionist trying to book that appointment, uh, was great, but I still haven't booked it simply because my expectation, like you previously mentioned, that if you want to order McDonald's, if you want to order a kebab, if you want to order whatever takeaway, you order it on your phone, and you expect it to arrive at your doorstep.

Jared 17:49

Correct. Everyone has Amazon to thank for ruining what made the customer experiences. Setting the bar high. Yeah, the, the bar is so high.

Sean 17:56

All I've, I've been getting was email, emailing, uh, emailing me to book with an online, uh, link or, um, uh, asking me to call the clinic to book. Um, I'm pretty busy, and I... All I wanted to do is someone message me on WhatsApp.

Jared 18:12

Push a button.

Sean 18:14

Push a button.

Jared 18:14

Push a button.

Sean 18:15

Um-

Jared 18:17

Yeah.

Sean 18:18

And what do you say to clinic owners who their clinics, I, I have to honestly say that they're doing a good job.

Jared 18:26

Yeah.

Sean 18:27

But the expectation of consumers these days, uh, from the hospitality perspective, from... It's... The, the bar is way higher than just good enough, right? What do you say to these, uh, clinic operators?

Jared 18:45

I think you need to make a decision about what kind of healthcare provider you're gonna be. And, and that's a decision for the founders or for the executive team. I- I'll give you an example. Um, we were speaking probably about five, six months ago with a multi-bill-- I think they do billion in turnover with a B, transatlantic group, private healthcare, hospital, uh, multiple enterpr- y- big, big organization, one of the big names in private healthcare. And we were talking about what happens when the patient reaches the end of their journey. And the answer, and he was very transparent about it, was basically nothing. Basically nothing. Forget recall and retention. You don't, you don't necessarily need to recall a knee surgery. You might wanna check in on them. You don't necessarily need to recall them in the same way, but basically nothing. And so I think from a values perspective, you need to make a decision about what kind of healthcare provider you're gonna be. Are you gonna be a healthcare provider who takes the onus and responsibility to follow up with the patient, to check in on them From intake to discharge and after. And I actually wrote about this recently, this idea of premature discharge. People often prematurely discharge patients. Patient comes in, you serve them, they say everything's fine, they leave. Six months later, they have a problem again. They shouldn't have been discharged. The idea that a patient journey ends because the thing you saw them for is no longer top of mind for them is wrong. There is undoubtedly a point in time, unless you're in chronic care, where that discharge can happen, but very rarely is it where the healthcare provider thinks that it is. So I'll give you another example. We work with a clinic. Clinic owner unfortunately had breast cancer. She went through scanning, surgery, et cetera. That provider follows up with her every single quarter and has done since the operation for obvious reasons. This is a different kind of care provision. Then they reduce the frequency to every six months. Now she's five or six years out of care, and now she's being followed up with once a year, and I presume that at some point that's gonna stop. That is a clinical level of responsibility that comes with that kind of care pathway. The question is, why isn't it happening elsewhere? And oftentimes the answer is it's really, really hard. It's not a check-in every three months on this thing. It's a much more regular consumer-grade engagement and responsibility that falls on the clinic. Give you a different example. Look at flying internationally with a premium airline provider. When you book a flight, they give you pre-check-in communication, check-in communication, pre-flight communication, in-flight communication, post-flight communication, then return flight communication, pre-check-in communication. There's a lot of communication. You know exactly what to expect and when. But there is a finite end to that journey. You fly somewhere, you fly back. In healthcare, there's no end, or the end is not necessarily where you expect it to be. So you need to be prepared as a healthcare provider to extend that patient journey well beyond what seems like the obvious endpoint. We just started working with a physio clinic, and they have 9,000 patients that have not been activated or in clinic for quite a while now. They've been around for a while. We're three days in. Patients are starting to reactivate. Some of these patients haven't in for six, seven years. Why now? Right? It's not like suddenly because we message them, their shoulder starts hurting. The shoulder was hurting already, but the barrier, the intellectual friction, the emotional friction to go from, "Oh, this is a pain. I have to call. I have to book. Life is busy." But you show up at the right time. You show up when they're lying in bed getting ready to go to sleep, when they've just had a workout in the afternoon, they've just picked someone up from school, they've just come home from work, whatever it might be. You show up at the right time, suddenly that access is easy. It's natural, and that is what patient access should feel like. It should feel like speaking to your friend. It should feel like texting or what's happening with your spouse, your partner, your child. It should be that easy. It shouldn't be sending an email, getting an auto-reply, "The office is closed from X to X. We will endeavor to get back to you in 72 hours." That is not an acceptable response if you're providing a healthcare service to a patient.

Sean 23:08

Interesting I was listening to the conversation earlier you guys were having about spamming. Um, "We don't want to intrude," quote-unquote. That is a phrase that many clinic owners- Yeah or operators said.

Jared 23:25

Yep.

Sean 23:25

Right? Oh, we don't want to intrude. We, you know, we want to respect our patients-

Jared 23:30

Yep

Sean 23:30

without sending too many messages, calling them too many times. But the experience or, or what I've heard so far, uh, about the outcome has been very different than what I expected in terms of how spammy can, quote-unquote, receptionist or front desk team or salespeople do, right? So there is a line. Why do you think... H- How would, uh, Coherent solve that problem, finding out where is the sweet spot of being What's the, what's the term for that? Being empathetic enough to care about the patient during a long period of time throughout the entire journey by reaching out frequently enough, but at the same time not crossing the line of come, coming across as spammy. Everybody has different tolerance when it comes to feeling, you know, being spammed. What is Coherent's approach?

Jared 24:34

Yeah.

Sean 24:35

From, either from SOP, playbook, system, process, or technology perspective?

Jared 24:41

Yeah. So there's that great saying that's, that looks like a duck and it sounds like a duck, it's a duck You send someone an email that has a branded banner with a generic template and a dear first name filled in, it's marketing. It's marketing. You can call it whatever you want. We haven't seen you in six months. Time for your next appointment. If it shows up with your dental clinic banner, it's marketing. Looks like marketing, feels like marketing. People are inundated with that kind of stuff. That feels like marketing. That's very different than conversational engagement. Conversational engagement is, "Hey, Sean, it's Sally. We haven't seen you in three months. You had that issue with your molar, ankle, cheekbone. Just wanna make sure everything's okay. You know where to find us That's a totally different message. The tone is different, the brand is different, the experience is different. There's genuine concern, not administrative, "Time for you to do this thing." The thing that I find so interesting is that if you look at the technology market, there are hundreds of millions, if not billions of dollars that are being poured into AI sales reps that figure out the right way to message a new customer. There are people who spend their entire career optimizing subject lines. These are growth marketers, people who are deeply invested in the when to send, what to send, how to send. But in healthcare, that doesn't exist. There's no analysis of the communication. There's no activation data. There's no signal back that says, "We sent four hundred emails. Only two hundred of them were answered." And we know this is the case because half the time that we start working with a practice, we come to find that twenty percent of the database doesn't even have the right phone number. So there's no system of feedback. There's no way to know that what you're saying to your patients is ever getting there. And so this idea of being pushy is fundamentally wrong. You know when you're being pushy when the patient tells you, "I'll let you know if I need anything." Cool. You've hit the line. Don't step over it, but that's when you hit the line. Patient writes back and says, "Thanks. I think I've got everything for now. I'll let you know if I need anything." No problem. You've hit the line. You've done your job. You've followed up. Now it's in the patient's court. But for every patient that says that to you, there are twenty who will respond and say, "Hey, thanks so much for checking in on me. I really appreciate it." Or maybe they'll say, "Oh, good timing. I was actually thinking about this," or, "Hey, it's actually weird. I haven't heard from the clinic for some time, so thanks for reaching out." So it's easy to think about the one person who's gonna say, "Nah, not for me." It's much harder to imagine the fact that there could be another twenty, another thirty, another forty, another fifty. And when you put that in real terms, in terms of clinic performance, these numbers are really meaningful. So if you have a hundred fifty new starters in a given month, you can literally double your new starters through reactivation of your existing patient body. Double. That takes your cost of acquisition down by two. It literally is a hu-- fifty percent haircut on cost of acquisition. No new marketing spend. You can't get that kind of performance Almost anywhere else in the clinic, unless you suddenly replace your medical devices with a medical device that's 50% the cost, you can't halve your salaries. You can't cut people out of the clinic. Your practitioners need to be there to see patients. There are very few things you can do that have that level of impact, and I think that's what practices should be striving for. They should be looking to achieve 10X impact and not settle for incrementality. And I think a lot of the software that people are buying right now is incrementality. Now I can do this one more thing. The one more thing doesn't move the needle, which is why you end up hiring five people, 'cause they move the needle. You need something that goes further than press the button. You need a system of work that goes further

Sean 28:55

It seems to be that the invisible, the quote-unquote, invisible leak- leak- leakage that has always been the problem, uh, which is, um, most operators or leaders don't see the problem, when you ask them the question, "Do you have a patient leakage problem?" Then they will say, "We have a system. We ha- we don't have that problem." Um, but for all the customers that you on- that Coherent onboarded, it-- there seems to be like, "Oh, we've seen a new world, a whole new world," right? "We never saw this coming. We never, you know, expected this level of results that came out from the process." Why, why is that? What's the

Jared 29:28

gap? What's the... So I think it's worth saying, like, sometimes we don't see those results. I think it's very important to be honest about that, and we say that to our clinics as well. We say, "We will come-- We don't know who's in the patient body. We don't know what your lead flow and quality is like. We have no idea." And so if we come in and we begin our work, and we come to find actually there's no reactivation, or maybe you have a really, really tightly managed patient database, or maybe when you discharge, you really discharge, then the impact of patient retention may be less, may be less visible. So maybe there are drops off-- drop-off elsewhere in the journey. But it's not always the case that you go in and suddenly you get a total water-- like massive explosion positive outcome. It's not always the case that that happens. It happens a lot, but it doesn't always happen. So the question is, when we arrive and people are already doing patient recall, what's different? I think there are a lot of things that are different. Number one is that we own that problem. So in clinic, please point to the person who owns this problem, and oftentimes the answer is nobody. People will say, "Oh, I have a patient coordinator." Cool. What's that patient coordinator's job description? Patient retention? If that's it, then you've got an owner. If they have even one more thing, and oftentimes it's ten more things or twenty more things, there's no owner. So number one is you have problem ownership. Same like hiring an accountant. If you hire an accounting firm or you hire an accountant in-house, they do the accounts. That's the job. They don't do the accounts and, and, and, and, and the legal and, and, and all the other things. They do that job. So number one is ownership and, and single-minded focus Big difference. Number two is data. Data is a massive unlock here because people are closing their eyes and shooting messages off, hoping that something comes back. There is no performance or analysis or insight as to what you say, when you say it, where you say it. No clue. And we get better all the time. We're very far from perfect. We're better now than we were a year and a half ago, but it's a constant journey of learning who gets a message, when do they get a message, where do they get a message, how do they get the message? What happens next? Do we call them, then email them? Do we email them, then we WhatsApp them? There's this constant experimentation and data feedback that we see in the work that we do that clinics just don't see. Even if they are measuring it, they're measuring it at a tiny scale. We're measuring it at an enormous scale. So number one is ownership. Number two is data, and as a result, impact from the work that we're doing. But number three, and this sounds inelegant, is just horsepower. Clinics are shocked at the amount of outbound communication required to capture interest and move people back into an on-track state. It's, it's shocking to them. It's thousands and thousands of points of communication. In a single month, there might be ten thousand points of communication. Clinics don't do ten thousand points of communication for half a year. There's a very, very big gap intellectually between how do you get that scale of communication and not lose the empathy and one-to-oneness. That is a technology problem. So when clinic says, "I'll just hire someone in-house." It's like, cool. Are they gonna sit down and write ten thousand emails tomorrow? Are they gonna send ten thousand WhatsApps the day after? Do you know that if you try and send ten thousand WhatsApps, your WhatsApp account is gonna get blocked? Do you know how to unblock it? These are technology problems. So when you say, "Oh, I can just hire a patient coordinator," no, because unless the c- patient coordinator is also a software engineer, which that would be very cool, but I don't think that happens very often. If the patient coordinator is not a software engineer, just like a software engineer is not a patient coordinator, you have a problem. You have a gap. And so the magic is taking the patient coordinator and putting them in the same room as the software engineer and saying, "Figure it out." That doesn't happen. Right now, you have patient coordinators in clinic, got software engineers somewhere else in the world as a supplier. They're not talking. They're not saying, "Oh yeah, this worked, this didn't work. Oh, hold on, this got that kind of response. That got that kind of response." That problem-solving happens between the human and the tech. But right now, those two things are disconnected. So what's different? Ownership, number one. Data, number two. Technology, number three.

Sean 33:49

Product team, just talked about this really cool WhatsApp compliance sentinel- that the engineering team has built.

Jared 34:00

Yeah.

Sean 34:01

You don't have to reveal too much details about that.

Jared 34:03

Yeah. What is it? Wh- why does it matter?

Sean 34:05

What is it, and why does it matter? Yes.

Jared 34:07

So I want you to imagine you're, you're, you're a large-scale healthcare provider. You're a, an NHS multi-site trust, and you've got hundreds of thousands of patients, and you need to tell them something. You can send them snail mail. Okay. Maybe it gets there, maybe it doesn't. Probably helps, but you don't know if they read it. You don't know if they did anything. So option one. Option two, you send them an email. Faster, but equally likely, arguably today more likely, to end up in the junk. I don't actually know if that's true, but very likely to end up in the junk whereas at least if someone receives a letter, they might actually open it. Email- Or

Sean 34:42

the promotional folder of Google, uh,

Jared 34:45

Gmail. Or the promotional folder, folder of your Gmail, absolutely. I mean, when we onboard NHS practices or NHS prac- practitioners who use NHS email, they filter out s- some of the correspondence, and they'll say that, "Sometimes I can't get my patient communication." So anyway, in the NHS context. So you have snail mail. You have email. Maybe you try SMS. There's some great SMS providers who are reaching out at scale, companies like Accurx, great providers who are doing this sort of outbound communication at scale. When you start to get into WhatsApp, things get really hairy. Why? Number one, very hard to manage at scale. Number two, very, very real possibility of just being locked out, full stop. One of the things we've been building in-house, which is what you're referencing, is this idea that a WhatsApp account has a certain health. Is it green and healthy? Is it yellow and not healthy? Is it red and at risk? Now, that's interesting, and people probably say, "Oh, I can probably do that for myself. I can go into my own account and I can look." Maybe. But here's what you can't do. You can't then adjust the messaging limits on the basis of that risk rating. So you probably stop everything, and then the whole channel dies. Whereas if you have green escalating to yellow, maybe you shouldn't just turn everything off. That's very extreme.

Sean 36:12

So the ability to fine-tune.

Jared 36:13

Maybe you can fine-tune, and it's a bit like a light switch. You can dim or you can flip it on and off. The dimming, the flexing, the up and down, that is the magic. That is where the engagement happens. The turn it on and off works, but it's very inelegant. It's very blunt, and that bluntness translates to patient experience, translates to patient engagement, translates to booking outcomes, translates to patient support, translates to activation. All of those things are downstream of a very, very small thing inside of a single communication channel.

Sean 36:49

Uh, that's very interesting and, uh, before I forget, there was some-- last question, um, retention versus leads, and something that was quite interesting to me was that even though that a lot of customers of Co-Coherent starts with-- started with retention, but they all want Coherent to also hand-handle, uh, uh, leads, inbound leads. Why is it-- That, that sounds to me that there are a lot of leakage happening on the leads level. Like when the new lead come in, somehow they drop out.

Jared 37:21

Yeah.

Sean 37:21

Or the clinics don't know what happened after they drop out, right? So they want either better conversion or better clarity. Why do you think Coherent's best s- uh, suited for that?

Jared 37:35

The number of clinics that are turning over millions of pounds per year that are running their lead flow on a Google sheet would shock you. You would fall off your chair. It's absolutely shocking. The number of clinics-- I'm thinking of a clinic in particular that do three or four million pounds a year in turnover, small scale private hospital. They have a lead funnel that is about as hygienic as Insert words, your choice. It's not good. Lead management is a data problem. Th- this is the-- I mean, all of it's a data problem. But lead management is a data problem. What I mean by data, I'll give you an example. We're working with a clinic right now. They get X number of leads per month, call it two hundred and fifty leads per month on average. They're looking at that number, and they're saying, "Okay, I got two hundred and fifty leads per month. Great. I've gotta convert some of them But then you start looking at those two hundred and fifty leads, and you realize that a large number of those patients have actually submitted an inquiry form more than once. In some cases, for whatever reason, they've submitted it four times. So you've got two hundred and fifty inquiries that now suddenly drops down to two hundred and twenty inquiries because a lot of them are multi-submission. Okay, maybe that's okay. Then you take those two hundred and twenty, and you look at their data. You look at their email identifier, you look at their phone number, you look at their name, and you push that against the practice management software, the EMR, EHR, and you suddenly realize, hold on a minute. These twenty-five people that look like leads are actually my existing patients. So now we go from two fifty to a hundred and ninety-five true leads. Now, what has that taught us? Well, number one, your cost per lead, totally wrong. You think you're spending X on marketing, dividing it by two hundred and fifty. You're not. You're spending X on marketing and dividing by a hundred and ninety-five because those recall patients, those existing patients, should not be coming back to you through your marketing funnel. They should be coming back to you through your patient coordinating, through your retention.

Sean 39:39

You're pretty desperate that

Jared 39:40

they

Sean 39:40

had to.

Jared 39:41

They're-- They, they-- I mean, your patients are telling you they want to come back if they're coming back in as a lead. It doesn't get any more clear than that. But you're spending money the wrong way because these patients are trying to come back through the front door as a lead, when in reality, they should have just been able to message you and say, "Hey, I'd like to come back in for something." Or you should have been reaching out to them proactively and saying, "Hey, this is what's on offer at the clinic. How can we help you?" So on and so forth. So lead management is a data problem, and I have nightmares about some of the Google Sheets that we have seen with lead data, moving people from one tab to the next tab, phone numbers that are missing digits, emails that don't even exist. You cannot convert new deals, you cannot progress leads, you cannot retain them in the lead funnel if you don't have good data. And so you can put in place a CRM. I won't name names. You can put in place a CRM. Can you systematically move people from A to B and understand where they came from and where they're going? It's really hard to do that. It's really, really hard to do that. And so a lot of the clinics that we speak to, we love to focus on recall first. We then start asking questions. We look at the data. We say, "Hold on a minute. You've had twenty-five people last month who showed up for consultation, but they didn't progress." That seems like a problem. You've got thirty patients a month who are canceling and not rebooking. That seems like a lot of people So you have these drop-off moments, and the true cost of that drop-off is not just the appointment value, it's the team time. The team time is always overlooked. "Oh, my team will just do the cancellation follow-up." Okay, cool, your team are gonna spend 20 hours a week individually managing tasks to follow up with someone. That is a massive draw on time. So when you're thinking about the true cost of managing cancellations, it's not just the 30 people who haven't rebooked, it's the 30 people who haven't rebooked, plus 20 hours times whatever you pay your front desk. That number starts to get really, really big. Then you start thinking about P&L transformation. How do I change the bottom line, not just the top line? So as a growth clinic operator, you should be thinking about that. You should be thinking about the time cost and the appointment value cost of the thing that you're losing in the journey.

Sean 41:55

The example that you gave just, just now, imagine that X amount of patients who, uh, practically leaked from existing patients to fill in as, uh, to fill in the form to come in as a new patient. Imagine the a- the amount of people who just couldn't be bothered to come back, and then, yeah, it, it seems to be that there's retention and, uh, lead management seems to be complementing each other and then fill up each other's holes-

Jared 42:21

Absolutely

Sean 42:22

somehow.

Jared 42:22

The, the, the thing that's really interesting is in this clinic when we're doing, we're doing lead conversion, we separate out existing patients even if they come in as leads, and what we saw there is that I think the conversion on an existing patient who comes in as a lead was 66%. That's really high. 66%. These are existing patients. That should arguably be higher if it's an existing patient, maybe. But by comparison to a standard lead, there's a big world of difference there. But those people shouldn't be marketed to. They shouldn't be a lead, and so you're spending marketing dollars in the wrong place, and you're treating them like leads. And everyone's in this, like, false land of positivity where it's just like, "Look at all of our leads." It was like, "Well, actually, 20% of them are not legitimate." So the numbers are wrong

Sean 43:05

One example would be, uh, obviously depending on, obviously, on the, uh, the type of clinics, right? Probably aesthetics, uh, medical aesthetics do this more. Dentists probably do this less, um, or physio. Uh, they spend quite a lot of marketing budget on meta ads. Yeah Uh, and then they broaden the net, uh, or they're targeting specific region of audience. Uh, but because they don't have that clean level of data, clean structure of data, they don't know who are the- their existing customer that, who are active or been here before. They didn't know how to remove them, ex- exclude them from their active targeting. So presumably they spend, I don't know, 30% of their marketing budget on existing patients who they sh- or, or even more, right, higher budget than that- 'Cause they're low-hanging uh, who should be managed completely in a different stack with relationship-oriented, uh, uh, um, activities to nurture them, bring them back rather than, you know.

Jared 44:00

Absolutely. No, no, I, I completely agree. And, and I think the, the biggest challenge or one of the big points of disconnect between CRM and PMS is that when you market and you acquire, you don't know how far they go. So if you're a cosmetic dentist and you have a patient journey that's 15 months long, patient comes in, you see where they came from, maybe you can track the lead source. They go through to a consultation, but you don't know how far they go because the thing that told you what got them there is a different thing than what tells you how far they go. So you may very well be spending a lot of marketing for channels and campaigns that only bring people in that go three sessions, whereas a completely different marketing campaign may actually take patients all the way through to session 15. So that targeting top to bottom of the funnel is really broken. It's really, really hard to get a good view of what's going on there, and it gets harder as you get bigger because there are more ways, more pathways for patients to come in, more ways for people to knock on the door. You've got referral volume, you've got phone, you've got web form, you've got ad set. You've got all these different points of entry. You have to try and get your arms around that thing. You have to try and figure out where are they coming from, not just lead volume, but how far do they go? What's the lifetime value of that lead base? It's a very, very hard thing to track.

Sean 45:23

I think it's time to bring back Michael Schumacher from HMDG to talk about this topic.

Jared 45:27

Yeah. Uh, which he's very passionate about 'cause he al- I, I re- I remember when we spoke to him, he, he, I think he said, uh, "Oftentimes we tell clinics, um, stop counting co- stop counting leads, count consultations or count whatever the, the, the sort of downstream of that is." 'Cause and he, and he's right. He's absolutely right. Lead flow is a, is a, is a false economy