Why Clinics Break Invisibly: Excel, Front Desks & AI Receptionists | BOAC #45

In Episode 45 of The Business of a Clinic, Jared Aron, founder of Coherent, explores why the business side of healthcare is still so operationally fragile.

Jared begins with a story from his own clinic: four separate systems, none of them speaking to each other, and a senior team member spending days every month tying everything together in Excel. From there, he explains why this is not a small-clinic problem — even sophisticated healthcare providers are still running major parts of the business through exports, spreadsheets, and manual reconciliation.

The conversation then turns to the front desk. Jared reflects on the mistake many clinic owners make: assuming the front desk is a single role, when in reality it becomes 50 or 60 jobs at once. Reception, hospitality, stock checks, social media, cancellation recovery, patient follow-up, and diary management all get layered onto the same team — then owners wonder why patients slip away.

Jared and Sean also discuss why “we have a system” often falls apart after a few follow-up questions, why operational gaps get worse as clinics scale from one site to many, and why durable revenue growth depends on more than simply increasing marketing spend.

Later, Jared explains the thinking behind The Business of a Clinic community, why healthcare needs more space to discuss operations and commercial infrastructure, and how Coherent Engage differs from a CRM, a Mailchimp-style automation tool, or an AI receptionist.

The episode closes with a discussion on AI doctors, AI receptionists, and the future of patient support. Jared’s view is clear: the goal is not to remove the human from healthcare. The goal is to remove the administrative bloat around them, so humans can spend more time doing what matters — serving patients with empathy, judgement, and continuity.

Transcript

SPEAKER_01 0:00

We have this image that we love to kick around like an octopus with one arm holding on to a phone and one arm holding onto a notepad and one arm holding on to a pencil. And that is exactly what it feels like when you're at front desk. And so the expectation that person is going to meet all of the standards that you set out is fundamentally wrong. And we lost a lot of people. In a healthcare setting, the problems get worse as you get bigger. As you have more patient flow, the likelihood of things falling goes up. And oftentimes it doesn't go up linearly, it goes up exponentially. You cannot achieve patient support at that scale without hiring 20x the number of patient coordinators, 20x the number of patient navigators. And then suddenly the whole business model breaks down. Because you don't have the ability to retain an extra 25 people, 250 people, 2,000 people. And so you compromise on quality. We don't believe that the fundamental bottleneck in healthcare is bad practice. We use bad operations, bad logistics, bad business. That robotic point of entry in this case converted new inquiries sub 50% of the time. So you think you're saving costs, but actually you're losing 50% of your new patient flow. That doesn't feel like great economics. So one of them was the uh booking uh scheduling management, one of them was payments, one of them was on the sort of CRM side, and then the other one was all things connected to marketing. And uh this was 2020. And I remember that none of these systems worked together. So we used pipe drive for uh inquiry handling, we used, I forgot the practice management software, but we used some practice management software. Then we had a uh a payment system with Square. We had the Square card terminal, but they didn't allow us to do all of our payments, so we had a few different payment services. And long story short, is we had these different tools, none of them talk to each other, and we had a person on our team whose annual salary, I think, was 90,000 pounds thereabouts, and she was sort of one of the strategic leads of the business. Maybe it was 80,000 pounds, 9,000 pounds. But at the end of every month, we had to do this incredibly complex work in Excel in spreadsheets and Google Sheets, where we would export every report from each of those tools into a spreadsheet, and we would run some model that had been built by us, by this person, over the top of it, just to try and tie up the four different sources of data. And bear in mind, we were a very well-funded healthcare uh provider business. So this was not um a small clinic, this was a a full medical device team. We had in-house engineering, it was a very mature operation by comparison. And even that team still had to spend almost two full-time days. You take that against that person's annual salary, that's a very expensive two days, just to do that work, to take it from this system and that system and that system, bring it into one spreadsheet, and start doing analysis. And the thing that's really scary is that I probably couldn't imagine a more technically qualified team to do better than what they did, and it still took them two full-time days a month. Now, when you put that in a clinic environment where you may not have in-house engineering, in-house finance, in-house data, you are talking about a copy-paste job or no job at all. And I think very often we speak to clinics, and this is the case in my clinic as well, it all looks good on the surface, and all you need to do is press the export button once. And as soon as you press the export button, everything falls down because you have to start moving things and manipulating it manually as soon as you press export. And this is one of the problems with healthcare system tools more generally. They let you get information out by pressing export. But the data work you need to do, once you press export, is not, it's not immaterial. And so now you're a clinic owner, you're a clinic group, even sophisticated operations, even people who are running mature, commercially driven organizations are still doing spreadsheet math. And it's one of the things we often say when we speak about the problem that we're trying to solve now. There is no commercial stack for healthcare providers. You've got booking systems, you've got medical notes, you've got scribes, you've got clinical intake. These are medical and healthcare aligned technologies and tools. They are not focused on the business. They're not focused on the operations. And so that is the thread that you need to follow. How many times are people pressing export? How many times are they copying things over from this sheet to that sheet? We spoke to a commercial director earlier today who runs a very big surgery, and his tool of choice is Excel. This is a clinic that's doing millions and millions of pounds of turnover, international operations. The place that he spends most of his time is in Excel. And that was the case in my clinic as well. I was living in Excel. And that is a huge problem when you are running a healthcare provider operation because Excel is static. It dies. The minute you put information into it, it's dead. It becomes uh disconnected from reality. And that's ultimately where a lot of healthcare providers are stuck right now. And it's where we were stuck when we were opening clinic.

SPEAKER_00 5:35

Susie, we were talking about patient experience, uh your own clinic owner experience. Before coherent, when you're running your clinic back in London and New York, was there someone on your front desk you quietly decided wasn't good enough? Uh you don't have to name names. Everyone. It's really unfair. Look, we um I mean the the the direction I'm going for was those that weren't good enough, but also just blame everybody that the patient slipping away maybe moved on before you understood the loss was baked into how the desk was designed and how it works functionally.

SPEAKER_01 6:09

So when we opened clinic, I think we made the same mistake that most healthcare providers make, which is assuming that the front desk is a job. It's not a job. It's 50 jobs, it's 60 jobs, it's 70 jobs. The front desk is not a place to hire into. You need to think about the job description. What are the specific roles and responsibilities at front desk? And I think too often, and we made this mistake as well, you think, I want someone at the front desk to greet people upon arrival. I want someone to look after them, to make sure that they meet their arrival checkpoint, that they've filled out their intake forms. I want them to be offered a drink while they're sitting and waiting. We're talking about private healthcare, of course. So you hire this person, and when you think about that person, you say, it would be great if they had two years or three years of retail experience. It would be great if they worked in a healthcare setting before. It would be great if they had a very clear sense of what service and hospitality should look and feel like. And so you go out and you recruit someone who meets those requirements. And that person is extraordinarily competent at those things. And then clinic starts to get busy and starts to get busier, it starts to get busier, and you say, hold on, I need someone who's also going to do a stock check and who's going to reorder some of my core retail and clinical supplies. So that person at reception now takes on this job. And then a few more months pass and you say, Hold on a minute. I don't really want to keep paying my marketing firm to do my in-house social media. So I'm going to ask my front desk person as well. And then a few more months pass and another job layers on. And then a few more months pass and another job layers on. And so progressively, what you end up with is a person who shows up or a front desk team that shows up and spends their entire day reacting. And this is what it's like to work at a front desk of a healthcare provider operation. The entire day is in reaction mode. You are responding to things that land in front of you. You never have time to be proactive. You never have time to think ahead, to take the next step. And this is exactly the problem because the reactive work is from the loudest patients. It's from the happiest and the most unhappy patients. It's from the patients who were in yesterday and the patients who are in tomorrow. And so you start to lose sight, you start to disconnect from this enormous body of ultimately paying customers who wanted to spend time engaging with you, but you don't have time for them. And so when we think about the people that we hired for front desk, we made that exact mistake. We hired people that we thought had generalist skills, who were approachable, who were thoughtful, who were well organized, and they were all of those things. And then we started asking them to do things that they were never going to be successful doing. And we got more frustrated. I got more frustrated. I kept saying, you know, hold on a minute, I don't understand. Why can't you just also do this? Why can't you also follow up with these people? And you layer this expectation on the front desk. They are never going to meet that target. We've got clinics that have teams spending 20 hours trying to rebook cancellations each week. 20 hours. You are paying people to stand at the front desk and they are constantly juggling. We have this image that we love to kick around like an octopus with one arm holding on to a phone and one arm holding on to a notepad and one arm holding on to a pencil. And that is exactly what it feels like when you're at front desk. And so the expectation that person is going to meet all of the standards that you set out is just fundamentally wrong. And we lost a lot of people. I remember letting go of a lot of people because we couldn't get alignment on what the role was. And I remember sitting down, I kept saying to front desk, this is the expectation of the role. And what I kept hearing back was, I don't think I can actually deliver that, or I can't do that during the day because I'm doing these things. And there was this real impasse. And then I remember we had uh one freak week where all three of our core front of house, front desk, were out sick. Actually, I think two of them were out sick, one was on holiday by complete coincidence. And so I took the desk. It's like, well, someone has to do this job. It's not going to be the consultants. Someone has to be at front of house, someone has to open, someone has to exclude. So I was there. And I think a lot of clinic operators, a lot of clinic managers, especially early on, they will find themselves doing that job because there will have to be overnight cover. I mean, I know clinic owners who spend time at front desk because they have a headcount shortage. And the reality is when you take that role on and you try and do it for a day, you realize very quickly what the problem is. And you realize why, and I realized why the pushback from my front desk was, hey, if you want to do those things, I need to not do these things. Or I need four hours in the back of the clinic where no one's going to disturb me. Because when you're at the front desk, you are literally self-serving people as they come in. You're self-serving Amazon, you're self-serving deliveries, you're self-serving issues. Someone comes in to test the fire alarm. You are the point of call for these issues. Those things take up time. And that's where that impasse is. And that's where I think a lot of that friction comes with management and front desk.

SPEAKER_00 11:08

So it's less it's not even a people problem. It's really just a system problem, right? Every clinic that you spoke with, they always have the answer of the literally the same answer that we have a system. We have this system, we have that system, we have this tool, we have that tool.

SPEAKER_01 11:23

Yeah. So a lot of clinics that we speak with, large, small, multi-site, multinational, single-site, one location, they uh they will say we have a solution for that, or we do that in-house. We hear this a lot. And the thing that uh that we always find is that it takes three questions to figure out if they're right. The first question is, what happens when someone X? So when someone cancels an appointment, or when someone reaches out by web form with an inquiry, or when someone hasn't visited for six months and they're due for recall. So what happens when X? And then you'll get a really good answer. Oh, my team will do this, my team will do that, and then this, and the automation happened there. Then what happens? And you might get another good answer. They'll do this and this and the that and the then what happens? Usually by the third question or the fourth question, the answers start to get quite vague. Oh, well, someone should do this, and you know, I think it will be that. And if you just keep asking, then what happens? Then what happens? And then what happens? You start to discover that after one thing, or maybe two things, nothing happens. And oftentimes the first thing doesn't even happen. I mean, particularly in MSK, physio, chiro, etc., there's this industry expectation oftentimes that the practitioner should be following up with their patients. Practitioners don't have time to do that. They don't want to do that. They want the patient to be looked after, but sitting down and sending one-by-one emails to the 15 patients that you saw the day before is not a sustainable way to run a practice. And so oftentimes there's this known, unknown, talked about, not talked about issue of head office says the consultants, the practitioners, the therapists, they will follow up the patient. And then they all sort of look at each other and say, Well, we know that's not happening. So there's this known issue of follow-up. And the reality is that most healthcare providers don't design for sustained, high endurance, durable follow-up. They're not thinking about supporting someone for five months, six months, twelve months, twenty months. But we often hear from patients, oh, what great timing. Thank you for the note. Or, oh, I was actually thinking about reaching out to you, or any other version of intent that shows there isn't an active relationship with the provider. Because if there were, they wouldn't have needed an extra note to reach out. They would have already reached out. And so there's this disconnect as you start to go into the what happens next. If you're a clinic leader, if you're a patient experience director, if you're an operations director in a healthcare provider setting, you should go and ask your team what happens next. Patient reaches out to you, what do you do next? Then what do you do? You will get within one or two minutes to the back of what happens next. And you will realize that a whole lot of things don't happen. And that is exactly the problem, the disconnect that we often see, and that I certainly saw in clinic as well. You don't have the infrastructure, you don't have the technology to help you with what happens next. And in healthcare, what happens next is half of the battle. Because a lot of things don't happen on the day, they happen after.

SPEAKER_00 14:34

They happen next. It's more like a non-stop loop or non-stop continuity problem that every clinic suffers from or struggles with, right? And this is clearly a problem, a known problem for single-site clinics, but much, much bigger of a problem for multi-site clinics because there is a degree of separation between the owner and the clinicians. Just reminds me of my podiatrist. She uh for years since I've been to her clinic, she's been very persistent with her marking emails. So every week or two, she sends the marking emails, updates, etc., like new uh Christmas, New Year, whatever days that she's working. And she's a single site, single clinician-led practice, right? So she manages her own uh uh patients. And the list is not very big, right? She has a limited amount of uh number of patients that she manages, and she kind of knows them by name or by face. But as soon as it crosses the line of single sites, the patient lists grow bigger, multi-clinician in one site or multi-clinician cross many, many sites, the bigger groups, the owners obviously are the one that's looking after the PL, the growth, the development of the brand, the business. And then everything disconnects. And then the continuity problem becomes much, much larger, becomes much uh more problematic. What was your experience in terms of looking at from that lens of view?

SPEAKER_01 16:00

I think in a healthcare setting, the problems get worse as you get bigger. As you have more patient flow, the likelihood of things falling goes up. And oftentimes it doesn't go up linearly, it goes up exponentially. You bring in a new service line, that brings its own level of complexity. You introduce a new practitioner, a new team member, you need team members, you open a new site. All of these things introduce potential holes, operational holes. We were speaking yesterday with a a clinic owner who says that he was running a clinic and he bought a second clinic. And as soon as he bought a second clinic, he came to realize what wasn't working. Because when you go 100% growth overnight, as he did, going from one side to two sides, he came to realize that the things that were known, that were implied, the subtext, the unwritten things in clinic one couldn't be easily exported to clinic two. And so all of these gaps in the operational process that people either didn't close or sort of juggled their way around, that was not something that could easily go from site one to site two. And I think that reality is very, very real for healthcare providers, including for those acquiring, because now you're acquiring a whole different set of operational standards at each site. And those internal operational standards are probably okay. How do staff take time off? How do they request time off? How do you track holiday? That's fine. But as long as that inconsistency doesn't touch the patient, as soon as that inconsistency touches the patient, now you're going to start seeing problems. You're going to start seeing gaps in revenue, you're going to start seeing gaps in marketing spend, you're going to start seeing gaps in the journey from intake to discharge. And so I think when you talk about a single podiatrist, the nice thing is that that single podiatrist can probably by themselves hold the context of their patient body. But as soon as you go to two practitioners, 20 practitioners, 200 practitioners, you imagine a multinational healthcare group, private hospital network, they have hundreds of thousands of practitioners. They have millions of patients. You cannot achieve patient support at that scale without hiring 20x the number of patient coordinators or 20x the number of patient navigators. And then suddenly the whole business model breaks down because you don't have the ability to retain an extra 25 people, 250 people, 2,000 people. And so you compromise on quality. And it's interesting, patient support, or if you look at customer support more generally, both in business and in consumer, customer support is one of the largest technology categories on the planet. It's up there with CRM. You look at Zendesk, you look at Pylon, you look at any of the new AI-native support platforms. Customer support is a dominant category in software, and it is almost non-existent in healthcare. There is no patient support platform. We see healthcare providers today try to retrofit something like Zendesk in, but the reality is that patient operations and support is a different animal.

unknown 19:02

Yeah.

SPEAKER_00 19:02

Now, quite a few multi-sites, very large multi-site group customers now, right? I think we can all agree that they are probably the best business people out there, very business savvy, very motivated. There are many clinicians who are very business savvy, but the pattern is very clear. So what was your observation after a couple of months working very closely with them, building the relationship, but more importantly, delivering results? What what was your observation about this particular kind of group, clinic owners who are business driven?

SPEAKER_01 19:37

So speaking to to someone in mind, um speaking to her recently, the thing that that appears to be very top of mind for her, and this is uh uh one one of the executives in in the group, is how do we create durability? This idea of something that can sustain itself, something that has the ability to go the distance. And I think a lot of that comes from the supply side of the clinic. How do you actually deliver your service? Do you have a strong retention program for your practitioners? Are the sites fitted out in a consistent way? Do they all look the same? Do they all run the same? So part of that durability is almost the engine room. The food needs to come out of the kitchen in the same way at the same time, in the same manner, every day. That's one part of durability. It's not the part that we are involved with, but durability at the supply side of the healthcare provision is about repeatability. Same thing every time, same thing every time. Keep it moving, keep it coming out. Usually healthcare providers are much stronger there because that's what they love. That's what people sign up to do. They sign up to provide great care. So from a supply perspective, durability is about repeatability and it's about quality. From a customer perspective, from a demand perspective, revenue perspective, when she thinks about durability, she's thinking about diversification. How as a clinic, as a group, do we become not reliant on one source of revenue, but establish many sources of revenue? A through expanding service lines, but B through ensuring that we hold the patient population inside of active care, not unnecessarily, but for the appropriate amount of time. We don't experience this drift, this disengagement. And equally, how do we get marketing efficiency? And I think marketing efficiency is a really important place for everyone to focus from a clinic perspective, but certainly from a group perspective, because when you buy and you acquire and you grow, your assumption is not necessarily that you can cut out half of the staff. That's a, I think, a lazy way of thinking about private equity. I think more often than not, it's about top line growth, it's about revenue growth at the SIP level. The easy way to get revenue growth is just to dump marketing money into it, but you don't have efficiency there. So, how do you build a durable revenue footprint, a revenue footprint that can grow without needing to put the juice on? In the marketing funnel in the same way. And in some ways, even to reduce that spend, this is really, I think, where the focus is. How do we make more with less? How do we get what they would call an organic uplift in revenue, not a paid uplift in revenue? And it's a very, very hard thing to do because it isn't a hire one more person problem. It's a revenue function. A very large international hospital group may have an entire chief revenue officer and a revenue team, and they may have analysts who are focusing on revenue, on revenue cycle operations. And even then, they don't have it all under control because ultimately it's a technology problem. So unless you have the in-house revenue function and you have the in-house technology function, there's going to be a gap. And certainly for groups that are scaling 10 sites, 20 sites, 30 sites, unless you are building your own technology in-house, custom, baked into your workflows to make sure that patients are supported in the way that you want, there will be gaps. The question is just how big are they?

SPEAKER_00 22:57

And especially every clinic operates differently, right? It doesn't matter if it's a bigger or smaller group or single sites. Every clinic owner or clinician has their own preference. Switching gear a bit, uh coherent uh successful event two weeks ago, and it was quite busy. A lot of group owners, CEOs, operators, clinician, consultants turned up. Why do you think it was busy?

SPEAKER_01 23:20

Look, when I was running clinic, medical aesthetics, dermatology, I spent a lot of time going to conferences. And I did that for a few years. Uh not nearly as long as many people in industry. They'll go for 10, 15 years. In some ways, it almost becomes a social gathering. I went to many, many conferences in that space. And what I found was uh number one, an overwhelming focus on the clinical component, which makes sense. You want to deliver great clinical care. And also a an underwhelming focus on the commercial components of running a clinic. There's this in aesthetics, you have an entire floor of exhibitors who are bringing new drugs, new devices. And then over in the corner, all the way on the left, you've got a tiny booth with one or two accountants, one or two marketing agencies, and these business services are the afterthought because everyone's excited about the new treatment, the new protocol. And the reality is that that setting, that focus on business is really lacking, at least in industry there. And I've been to similar in MSK, I've gone to some dental conferences, I've gone to GP conferences. There is a huge focus on patient care, rightly so. But there is an absence of focus and time and energy and expertise around the business of a clinic. And not necessarily having it as an afterthought, but having it be the main event. And so I think what we tried to do with this event, and what we will continue to try and do, is to make space and to build an environment that allows people to show up and talk about business. Because if you're running a clinic, you're running a business. If you're running a single-side clinic, you're running a business. If you're running a multi-side clinic, you're running a business. We spoke earlier today with someone who has a runs a team of 54 people. All of them are on the business side of the house. Administrators, booking specialists, switchboard, credit control, these are the enabling functions of healthcare provision. The narrative, the space, the community to focus for the business side of the house is not mature. And so the event, and I think the turnout, was the result of trying to focus on that message and that narrative and giving operators, C-suite founders, the space to come together and say, okay, we know we're delivering healthcare, but why don't we also spend some time talking about the plumbing? Why don't we spend some time talking about the logistics? Why don't we talk about the operations? And it was a really interesting experience because even though everyone there was in and around the healthcare space, there wasn't a lot of talk about what's happening in the treatment room. There was a lot of talk about building a scalable organization, scaling operation, thinking about growth. These are things that keep clinic owners up at night as much as providing high-quality care. And so I think that space is white. It's empty. And it's a real shame because if you look at some of the provision now in the UK, as an example, the constraints, the limiting factors, are often operational. I spoke with a GP trust leader who was talking about the challenges that he had recalling patients who had outstanding blood work to do. That is logistics getting in the way of clinical delivery. The problem was not that they don't know how to do bloods, the problem was that they couldn't get people to show up. That's logistics problems, operational problem. And so we too often focus on that one moment of care provision, the acute point of entry, and we don't do nearly enough to think about the human beings moving around this system. And ultimately, and this is one of the big takeaways from the event that we ran, technology has never been more aggressive in its ability to move the needle. And it's also never been more about the people than it is right now. Because healthcare is the people business. You're moving people around. Patients have to go from A to B. Practitioners have to go to A to B. Maybe in 10 years or 20 years, that's not the case, but it is right now. You need to move things around. That is a logistics problem.

SPEAKER_00 27:22

And I would imagine that's the reason why you set up the business of a clinic community for business-oriented operators, owners to come together.

SPEAKER_01 27:32

I didn't um I didn't find my way into healthcare as a clinician. I don't come from a family of doctors. I have great respect for practitioners, but I think a lot of people who end up working in healthcare have some connection to the industry. I did not. I came into the industry in some ways by accident. I found my way into a medical device opportunity, which I thought was very interesting, and then eventually into healthcare provider setting. And for me, as a non-clinician, as someone who didn't have a deep understanding of the clinical journey, I felt the experience coming into industry was very lonely because I found myself speaking to healthcare leaders who had a lot of things to say, but these were things that I didn't inherently understand. And they were not immediately relevant to my day-to-day. I didn't show up to clinic every day thinking about the patient experience in the treatment room because we had consultants who were doing that. We had therapists who were doing that. And my job was to keep the lights on. My job was to make sure that there was four-wall profitability. And there was no support system there. And the thing that's really terrifying is that a lot of the business gurus that I initially gravitated toward don't have operator experience. And so it's terrifying to be handed out marketing or new patient acquisition or retention advice from someone who has spent their entire career coaching. It's not a disrespect, it's just reality. If you have not been in the provider seat, you don't understand the reality of confronting these challenges. So for me coming into industry, it was very lonely. And I often found there was an absence of support, of community, of knowledge sharing. And I found myself actively, I remember this very vividly, actively reaching out to clinic owners and clinic managers on the same street as my clinic, saying, Hey, how do you solve this problem? What do you do? There's an IV trip clinic down the block. I remember going in with coffee. I said, Can I speak to the clinic manager? Clinic manager comes out, very, very apprehensive, uncertain. And I said to her, I was like, listen, we opened clinic up the street. We're having these challenges. Have you had these challenges? It was a phenomenal relationship. We spoke maybe once, twice a week. We got together. Hey, oh yeah, I spoke to that supplier. They might be good. Check with this person. Oh, yeah, this is how we handled that. Oh, we did it differently. But we I had to really work to find that community. I had to work to find that space. You don't have that as a clinic leader. And so I think the business of a clinic is meant to be the backdrop to those conversations so that people can be together with the knowledge that they're showing up to have that discussion. And I think that's really important.

SPEAKER_00 30:05

And it's it was quite interesting that quite a lot of people who turned up were owners or senior operators at clinics, but not clinicians. Right. Including some customers, some just literally turned up by referral, and they all kind of interested in one thing that to come together with very like-minded sort of cohort of people. Speaking of the large customer that you just spoke with earlier, he was calling CRM of this thing that Coherent is designed for, which the name of the product is called Coherent Engage. So if you ever explain to customers or prospects about Coherent Engage, they're clearly going to say something like, Oh, is this a CRM, right? Or this is a Mailchimp like. How would you respond to that? How do you explain the difference and the challenge or the problem that or the benefits that it serves? Earlier today, I had co-coffee with someone that I used to work with, doesn't work in healthcare, doesn't know anything about what we're doing.

SPEAKER_01 31:03

And she asked, What is coherent? What is coherent? So I said, Oh, we coherent engage and this is how it works. And she didn't really get it. She doesn't work in industry. And and so she said, Can you explain it to me as if I'm a five-year-old? I said, Yeah, sure. Imagine if you could talk to your healthcare provider and they could talk to you like messaging your friend or messaging your spouse or messaging your cousin. That's the end of the sentence. That's how you explain it, right? You want patients to be able to engage access as easily as they would, hey, do you want to grab coffee next week? It should be as easy to access care. It should be as easy to re-engage as it is to arrange coffee or lunch with a friend or to message a family member. It should be that easy. If we can achieve that easiness for patients, the likelihood that they don't disengage from their care pathway goes up. The likelihood that providers can sustain high quality care goes up. The amount of debt and financial pressure that comes into healthcare organizations and systems because patients drop off too early is astronomical. You think about an oncology pathway where a patient gets halfway down the journey and then stops. You talk about blood work, people get halfway down the journey and they stop. Things need to restart. Think about physio, people get halfway down the journey, the problem does not resolve, they have to restart. This partial completion issue, the issue of going halfway, of going two-thirds of the way, of going three-fourths of the way, that issue is not a CRM problem. CRM has existed for a very, very long time. HubSpot has been around for many, many years. Salesforce has been around for many, many years. CRM has existed as a category, and yet healthcare is still struggling. And the reason that healthcare is struggling is because the complexity of the patient journey means that you don't have one sequence, two sequence. You have a thousand. You have thousands and thousands of sequences, and you have thousands and thousands of differences of patients. When you start multiplying these numbers together, the complexity is enormous. And to think that a healthcare provider can set up on their own all of that, manage the inbound, manage the outbound at scale with a team of five people or 50 people is flawed. And I think that's where we find the difference between CRM and what we're doing at Coherent Engage. Coherent Engage is about enabling access. It's about taking the friction out of the next step for the patient.

SPEAKER_00 33:32

So it's essentially a patient communication portal or system that basically enabling always-on continuity or always-on communication between the healthcare provider and the patients.

SPEAKER_01 33:44

I think you have to imagine what would it feel like if every patient had a patient coordinator? What would it feel like if every patient, no matter their healthcare provider, had a place that they could go and communicate and engage with a healthcare provider easily, seamlessly, quickly? What would that feel like?

SPEAKER_00 34:01

Wouldn't that be the AI doctor that both an AI is building or anthropics are building?

SPEAKER_01 34:06

I don't think it's the AI doctor. Why? Well, I think there are two reasons. First one is I think there are certain care pathways. I'll give you an example. So I have a very good friend who took his son to a maxillofacial specialist, I think I've talked about this before, who bruised his cheek. Now, could an AI doctor have looked at this two and a half year old's cheek through a phone, through a video? Probably. Would they have been able to determine the sensitivity? I don't think so. Certainly not from the patient's own home. How can they figure out if the two and a half year old who can't clearly articulate the pain that he's in, how can they figure out if when you press like this, the child winces or doesn't wince? How can you establish clearly, in this case, pediatric maxillofacial specialist, what the condition is? Now that may be very different than different care pathways where some of that triage can't happen remotely. But there are parts of the healthcare provision and healthcare ecosystem that for the foreseeable future, I believe, will continue to be in person. A whole lot of things need to change in terms of infrastructure to allow for everyone to have a fully functioning doctor in their pocket. The complete detour is a very interesting, interesting reference. A couple of years ago, there was a lot of talk about, you might remember this, evitals, electric vehicle, takeoff and landing, this idea that you could have flying cars. There's a lot of money going to flying cars, like AI doctors, flying cars, flying cars. Turns out the problem was not, could you build a flying car? The problem was where would you park it? The issue was infrastructure. Cities are not built to support flying cars. Where are they going to fly? You know, bum bit stuff. Leave them on the roof, put them down on the street. The infrastructure's not there. So AI doctors probably do help for certain care pathways, maybe for remote monitoring, chronic conditions. AI dentists. I'm not a dentist.

SPEAKER_00 36:01

AI physio.

SPEAKER_01 36:02

I'm not a dentist. I would like to believe that we are very far away from there not being a dentist in the room touching your mouth. I could be wrong. I mean, I there's an AI physio that just came out. Uh it's being used by parts NHS. Seriously, yeah, they just raise a lot of money. It's an AI Physio, and you take a picture of yours, a video of yourself, and it triages it and makes recommendations. And I've spoken to some physios about this. I said, you know, have you have you seen this? Have you heard of it? And they all say the same thing. They say, we're really happy it's here. Why are you happy it's here? They say, well, because in some cases, patients genuinely can't get any access to a physio. If the option is no access, or this, this. Every day, this. Because being in pain or having something that might help, this. And then there's the throwaway comment, but I think it's the real one. The throwaway comment is, and also when they try this, we know they're gonna come to us. Because they'll try it. In all likelihood, it won't give them the manual recovery they need. And so eventually they come to us. And so I think that when we're parts of the healthcare ecosystem that AI if I how quickly, I don't know. But I think for us, in terms of coherent engage and what we're trying to build with patients is not the clinical pathway, the administrative pathway. We don't think, we don't believe that the fundamental bottleneck in healthcare is bad practice. We need bad operations, bad logistics, bad business. Yeah, I can't imagine uh AI Botox or I just imagine you walk into a clinic, you lie down, and a robotic pair of hands do a facial injection on you. I I mean Today. Today, I just don't think so. I mean, I could be wrong. I mean, I I I was very involved in building medical hardware. The preclinical and clinical regulatory requirements of taking something to market that might touch your skin is not to be laughed at. The reliability standards are not to be laughed at. So you're talking about what, a robot doing a facial injection? I it's possible. I don't I don't know. I like maybe I'm conservative, but I just don't think we're there.

SPEAKER_00 38:11

I don't AI receptionist.

SPEAKER_01 38:13

You know, AI receptionist, I think go back to this where we started the conversation. What is the job of the receptionist? What is their actual job? If their job is to answer the phone, then sure. You can solve it partially with an AI receptionist. I don't think that's the job of a receptionist. I think that's a job of switchboard. Call it an AI switchboard.

SPEAKER_00 38:31

And what is the difference between coherent engage and AI receptionist?

SPEAKER_01 38:36

We don't take the human out. Coherent engage is not about removing the human. It's about making the human exceptionally efficient at doing what? Doing the job of serving the patient. It's about allowing the human to monitor, intervene, take the necessary steps to preserve the integrity of the patient-provider relationship without getting lost and drowning in the administrative fat around the system. It's about removing bloat. It's about removing excess. It's not about removing the human. I mean, we have patient quarters right now who are able to move through a volume of correspondence and patient handling that almost seems impossible when you compare it to using Microsoft Teams and Outlook inboxes and disconnected communication tools and needing to go between three tabs in order to respond to a patient. When you think that is the baseline, what we are doing seems impossible. And how could you have a human doing that? Turns out, if you take out a lot of the switching, the moving, the tab jumping, the SOP jumping, and you make that the technology problem, turns out humans got a lot of time. That time is about providing the appropriate care, empathy to a patient who's reaching out because they have a problem. And, you know, we hear this from clinicians now. They put in place an AI receptionist. We have one clinic group we're talking to talking about right now. It's a five-site MSK group. They put in place an AI receptionist. Now they are leaving the AI receptionist. Why? Not because it didn't answer the call. It answered the call. It did the job. That wasn't the job. The job was to help patients book in the consultation. So if a patient called in and said, I want to book a consultation tomorrow at 2 p.m., great. AI receptionist did the job. But when a patient called in with a question or when there was some kind of friction or misunderstanding, they didn't. Patient was not moving forward their care journey because they came into this robotic point of entry. That robotic point of entry in this case converted new inquiries sub 50% of the time. So you think you're saving costs, but actually you're losing 50% of your new patient flow. That doesn't feel like great economics, doesn't feel like great business. Which is, again, not to say that AI voice doesn't have its place in healthcare. It does. There are some administrative questions that can be handled successfully reliably with AI, and we should let AI do that. But figuring out which conversations those are, figuring out where the human needs to live and where the AI needs to live, that's the hard part. That's where you build repeatability reliance scale. That's the hard thing.