Chris Madden:
This is our final episode of the season. When I look back at everything we've covered, one thing stands out. Digital health isn't just changing how care happens, it's expanding who gets access to it, making it specific to your precise needs, and providing great care to people who may have been shut out of it for years.

This is Marketing Digital Health, and I'm your host, Chris Madden. Today we're zooming all the way out, not just a single topic about a single channel, but the bigger picture, the impact digital health is having on patients, providers, payers, and all of us as humans navigating our own health journeys.

And to bring this home, we're bringing back three incredible voices. Ankit Gupta, Joanna Strober, and Dr. Aabed Meer. They each bring a different angle, but they overlap in the same mission, using innovation to reach people who need care the most.

Let's close out this season the same way we started it, focused on people, access, and the future we're building together. Digital healthcare helps remove critical barriers and is changing the way patients are treated.

For example, patients with opioid use disorder, which can carry a stigma. We introduced Ankit Gupta in episode 16 on navigating state level fragmentation.

Ankit Gupta:
Yeah, I've been horrified as I was starting to work on Bicycle Health and seeing how treatment gets delivered in other places. I've even seen cases where patients were literally in handcuffs in the clinic as they were going through treatment, supervised drug testing, someone would literally see them pee in a cup.

So we wanted to create something that is highly friendly, accessible, convenient, confidential, while at the same time works really well, provides great outcomes, and proud of the work that we've done to be able to do that.

So our treatment model is still based on top of the evidence base that exists for opioid use disorder, but we have really evolved it and adapted it for the telehealth and digital health setting.

Core aspect of our treatment model is medication management. We prescribe buprenorphine based medications that are highly effective, that have a strong evidence base to overcome withdrawals, overcome cravings, and really help people get into recovery and stay in long-term recovery.

One of the first things that patients receive is an appointment with one of our medical providers. They're trained in addiction medicine. They're trained in our protocols, and they help patients obviously assess their condition, but then start a treatment program that includes getting off of their opioids, going into trial, and then tapering up the dose of buprenorphine little by little to get to a point where they don't have withdrawals anymore and don't have cravings anymore.

Once patients are fairly stable on the medication, and that takes about a week or sometimes more, then patients start engaging in a lot of other aspects of the program. For example, if the patients need some sort of behavioral health intervention, we have a therapy program in-house, or we have partners that provide therapy for our patients.

Often patients might need behavioral health support, but maybe don't want therapy or don't need therapy. We have a large team of recovery coaches or peers who have lived experience of addiction, whether that's their own or whether that's through friends and family members, and so they run thousands of support groups at this point across the day, across the week, 150 different types of support groups.

And in addition to that, they also provide a lot of one-on-one counseling and support for our patients. And so this is a highly engaging program that's based in-house. We're really proud of that and it really helps engage patients in between those medical appointments where lots of ups and downs happen and we want to make sure we can prevent relapse as much as we can.

We also allow patients or engage patients in a lot of the wraparound administrative support that often in clinics they think of it as overhead or they think of it as just operations. We actually think of it as critical to remove barriers to staying in treatment or prevent relapse.

So we have staff members who help patients locate pharmacies to fill prescriptions because unfortunately there's a lot of stigma about this and a lot of pharmacies either don't want people entering treatment to be filling the prescription at the pharmacy or just don't stock this medication enough.

And so we built a proprietary tool to locate pharmacies that will actually have the medication on the shelf, and our staff helps patients. They go through lots of hoops to help the patient actually fill their prescription.

Similarly, we have a team of financial coordinators that help the patient really understand the bills and work with them to make sure that the patients can actually stay in treatment and afford the treatment as much as we can.

And so a lot of the support services that the patients need to, again, remove those barriers in treatment.

Chris Madden:
The ability to put yourself in the shoes of your patient is one of the biggest differentiators I've seen between ordinary founders and truly transformational ones. And you can hear that in the way Ankit talks about treatment, not just the clinical steps, but the dignity, privacy, and respect that patients deserve.

Ankit Gupta:
90% of patients with opioid disorder don't have access to treatment. Studies have also shown consistently 90% of people with addiction don't want treatment.

If you put those two together, to me, what that signals is that if I ask you a day, any day, whatever, 10% chance you want treatment. But over the course of a few weeks, or over the course of a few months, there's probably a time that comes when you really want treatment, and if in that moment you don't get the help you need, it's so easy to go back to the usual habits and that moment might not come for a long time.

So for a lot of our patients, when there's a significant life event happens, maybe the birth of a child, maybe some acute event, maybe an overdose, or maybe just something that makes you realize, hey, there is a different way that I can do this. Maybe a friend or a loved one is doing really well.

And so when I think about marketing, I actually think about putting myself in the patient's shoes and thinking, how do I actually be available for this person when they need us the most? And for me, digital marketing is a great way to do that.

For a lot of people in a new way that we have to offer. And so if we run ads on Google, as patients are searching for things, if we show up on their Meta feeds or their Instagram feeds, often what we hear is, oh my God, I didn't even, I wasn't even looking for Bicycle, but I'm so glad that I found you, because I was able to turn my life around.

And so I think in that sense, digital marketing is a really amazing tool to be able to be next to a person in their pocket, available when they need it. And we've really optimized our operation to be able to really engage those patients in those times.

So we make sure that same day, next day appointments are available. We make sure that our providers are cross-licensed across multiple states, across multiple health plans or credentialed so that they're able to take a wide variety of patients as they're coming through the door.

And so many more enrollment operations that help us really make sure that we're available for the patient when they're ready for help.

And you can really take that to the next level through thinking about B2B, where how can Bicycle be in the lobby of the jail when the patient is leaving the jail and they now are gonna go back into their community setting, but they're actually in treatment now, whereas maybe when they got in earlier, they might be in active addiction.

And so how are you there? How are you in the lobby of yours*? How are you actually in the state Medicaid offices when someone is ready to enroll in Medicaid so that they can engage in treatment?

And so how can Bicycle be where the patient is with the street team as they're going around and engaging patients overnight, trying to get them help. And so in my mind, marketing is more than marketing. It is being there where the person is in the moment that they are ready to change their life.

Chris Madden:
Finding new ways to reach patients can't just be a passion project. It has to be backed by a model that works. That's where Joanna’s perspective is so important. She brings the business reality. To help people at scale, the company has to be sustainable.

But what I love is that even though Joanna and Ankit approach the problem from different sides, the end goal is identical: access for people who were never served before.

Joanna Strober is the founder and CEO of Midi Health. We introduced Joanna in episode one around why marketing digital health matters.

Joanna Strober:
I recently was talking to the head of Google Ventures, and they're one of our largest investors, and there's a woman partner there named Frederic*, and Frederic pitched us the first time and she got turned down by the partnership.

And she pitched us again and she got turned down and she pitched us a third time and she got the funding.

And what the head of Google Ventures said was, she wouldn't give up. She really believed in your company and she was persistent and not giving up, trying to get the company funded.

Not because she was trying to do the right thing, but because she believed that our company could be a really big company and we need women like her out there who are pushing their partnerships and saying women's health is a big opportunity.

There is a lot of money to be made in serving women's health, and therefore we should be making investments there, and that is what's gonna drive the opportunity. It's not done for the benefit of humanity, although it is for the benefit of humanity. It's done because money can be made.

Chris Madden:
Joanna and Ankit share the same theme we've heard all season. Large groups of people who were once invisible to the healthcare system are finally being reached.

And telehealth isn't just for younger tech savvy patients. It's become the default for anyone who wants care that feels personal, efficient, and accessible. It's a reminder that digital health isn't replacing human connection. It's enhancing it.

Joanna Strober:
What we found is that lots of women haven't had blood tests. They haven't had cancer screenings. They don't really know what's going on with their bodies. And so they've been lost to care after having their children and they've stopped taking care of themselves.

So we launched this visit and what has been interesting is how many older, and I'm gonna put myself in the older category, women are coming to us. We thought it was gonna be more women in their thirties and forties. That's who assume, presumably is using telehealth.

And we found that actually it's lots of women in their fifties and sixties who are coming to us who are very interested in getting up to date care.

So what that tells me is that telehealth is a pretty broad range of age categories. I think there's a belief it might be younger people, but it's not. It's a very broad range of people.

The way I see healthcare going is that 90 to 95% of care can be done on telehealth. Sometimes you need to go to see a person.

I had a woman ask me the other day and she said, I was really surprised. I went to my primary care doctor for my annual visit, and she didn't do one thing that you couldn't do on telehealth. She said, so why did I drive there? Like, why did I go sit in the office and why did I drive there and why did I take off all my clothes and go sit on this chair when in the end all we did was have a conversation?

Most care is a conversation. You don't need to look at your body for that, for most care.

So I think that most care will be delivered like this. It will be you and I talking, and it's a very efficient way of providing care. You don't have to drive, you don't have to waste the time.

And then when you need in-person care, there will be pathways for that. And so the hospital systems will be much more set up to partner with digital health companies. And if you need an in-person visit, they will take you for that in-person visit.

So I'm actually very excited by that future. It may be instead of having to wait six months to get into an in-person visit, you'll have to wait less because it will only be in-person visits that really need it.

So I think the care pathways are really important. I think digital health companies need to set up these care pathways like we're doing to get you in when appropriate.

So we have a system set up now with a number of hospital systems, including Mount Sinai, Memorial Hermann, MultiCare, USC, where if you see Midi and then you need in-person care, we get you in quick.

And I think that is the most important thing, is those connections so that women can get the care they need. And when they need the in-person care, they can get in very fast.

Chris Madden:
What we're doing in digital health isn't easy. Every company is navigating new ground, new regulations, new patient expectations, and new ways of finding people where they are.

Ankit is building new pathways to care, not just new marketing channels. And when he talks about how referral relationships evolve, you can hear how much operational discipline is required to grow responsibly.

Ankit Gupta:
And we're learning a lot about how to engage in referral partnerships.

We started with D2C because that's something I'm familiar with. That's something that really does reach the person where they're at. It's highly scalable and you can get a really strong engine going. It's completely opposite of what the traditional health services world does in a sense.

It was a channel that was completely unexplored for opioid disorder treatment providers, especially at the national scale that we're at, and especially for patients with commercial insurance.

And I think that Bicycle, we've really grown into that channel and optimize that channel. Thanks to your help, obviously, to help us get started on that. And that's something I'm really proud of because of that work.

We've now seen, obviously, thousands of patients. We've seen close to 50,000 patients across all 50 states. We have been doing this work for several years now, so we understand our patient base really well.

We started off as a self-pay provider, and then we started building insurance contracts. It takes a long time to develop significant insurance coverage in a market such that a referral partner can actually take you seriously, because for them, they don't wanna choose, oh, I'll only send you Blue Cross patients, or I'll only send you Medicaid patients.

For them, it's like, I'll send you all the patients as long as you can actually take care of them.

And so necessarily referral based acquisition had to come much later because we needed the patient base in order to get insurance reimbursed, in order to then actually engage referrals.

So now is the right time for Bicycle, where we've built a brand, we've built a patient base, we've built a really strong channel that can be a core channel for us, the D2C channel.

And now we're in markets and we're only in a handful of markets where we have pretty much 100% insurance coverage.

And so when we go to a jail and talk about how they can refer our patients to us as they're reentering into the community, or we go to, let's say an agency that has peers and those peers are embedded in emergency rooms, those peers now have a telehealth option that they can refer our patients to because we accept all insurance in that community.

And so it's really, the value proposition is really resonating now where we're having those conversations and we're partners that are on the ground to refer patients to us.

And as we build more sort of robust insurance coverage, especially on the Medicaid side, that opens up more markets for us to go and build those kinds of referral partnerships.

Chris Madden:
And what started this surge in telehealth? The COVID-19 pandemic. That moment that pushed telehealth from a nice to have to a necessity almost overnight.

And as Dr. Meer explains, with that rapid growth came equally fast regulatory changes, all meant to keep care safe, effective, and grounded in real clinical value. It's the biggest shift we've ever seen in how people access care in our country.

Dr. Aabed Meer is a physician and investor. We first introduced Dr. Meer in episode one when he contributed to our discussion around why marketing digital health matters.

Dr. Aabed Meer:
The digital health landscape was certainly gaining momentum before the pandemic and was on an upward trajectory because of a lot of secular trends. The pandemic accelerated that transition to the point where we almost had a melt up in digital health.

If you've looked at the number of companies that were being created, if you looked at the valuations of these companies, it definitely seemed like a peak, and many of us questioned the sustainability of that.

After 2021, the market certainly shifted from a growth at all costs market to one where the focus really was on profitability, operational excellence, and being able to have a real clinical impact.

And that's certainly been a transition for the industry. And today, investors are largely favoring companies that demonstrate a clear ROI for all stakeholders. That includes patients, providers, payers, employers, and aren't just focused on engagement metrics.

And in parallel, regulations have also tried to keep up with the evolution in utilization, for example, that we're seeing.

And ultimately, these solutions have to be user-friendly. User-friendly for the patient, user-friendly for the physician, user-friendly for the payer, user-friendly for the employer.

And one way to do that is to have a robust platform solution as opposed to a point solution.

And ultimately the goal is to understand the healthcare ecosystem and integrate these solutions into the healthcare ecosystem, which is we spend north of 4 trillion today on healthcare, and regardless of how big any individual company is, it still has to figure out how to play within that ecosystem.

Chris Madden:
Turning a point solution into a platform is something we've seen across many companies this season. You start with a problem, a pain point, and if you do it well, you earn the right to expand.

What Dr. Meer describes is something founders struggle with. Knowing when to stay focused and when to scale. And getting that balance right is what determines whether a company stays small or becomes a category leader.

Dr. Aabed Meer:
Point solutions address very specific pain points in any workflow or process, and almost by definition, most companies start out with great point solutions.

And there's a lot of value in developing a single solution for a single problem that really addresses that problem incredibly well.

Part of the transition any successful company that is trying to scale has to make is to turn that very, very successful point solution into something that's more of a platform solution.

And that takes time, that takes energy, that takes process in terms of how you sequence the steps to get from a point solution to a platform solution.

And so it's inevitable that you start out with a point solution oftentimes, but in order to be not just successful, but a scaled company, it is important to have a platform solution.

Chris Madden:
Dr. Meer shares a great example of how solutions evolve over time. When you zoom out and look at the bigger healthcare ecosystem of payers, employers, providers, and patients, you start to see the adjacencies more clearly, and that lens is what helps founders avoid common mistakes.

It's not just about building a great product, it's about building a product that fits into a 4 trillion dollar system.

Dr. Aabed Meer:
One of the exercises as an investor that's important is to go through thinking about what the arc of that company could look like. Thinking about what adjacencies are there for any given solution or company, and having insight into what is more or less attractive.

And when I'm making an investment in a company, a lot of that is happening upfront. Recognizing that the path the company takes can certainly change, but it's important to have a view.

And what I've benefited from is having context around what the healthcare ecosystem looks like versus working within a specific silo.

I'm thankful for my background as a physician, as a scientist prior to becoming an investor, and my ongoing involvement with the operational aspects of healthcare as a physician.

And so ultimately you want to be able to think of any solution within the broader context and figure out what are the most natural adjacencies and is this a market we would go into or not in doing that work up front as much as possible.

Chris Madden:
New technology continues to push the industry forward. Every time you remove friction, whether it's prior authorization, scheduling, or predictive monitoring, you buy back time for providers and improve outcomes for patients, and that's part of the real promise of digital health.

Freeing people from busy work so that they can focus on delivering great care.

Dr. Aabed Meer:
Broadly speaking, the ability to apply technology and software to workflow issues that have historically been very services oriented, the opportunity there is tremendous.

Prior authorization, as an example. That's an area that historically has been very analog, and now you have the ability to apply software and technology to make that problem not completely go away, but at least make it easier to deal with.

If you think about predictive analytics that anticipate when a patient is gonna deteriorate before the patient actually deteriorates, there's tremendous value in that, and you can use predictive analytics to then tailor treatment plans for patients.

Chris Madden:
We've talked about AI a lot this season, and the thread across all our experts is the same. AI is here to stay. It's powerful. It's fast. And it's evolving at an incredible pace.

Dr. Aabed Meer:
We're certainly hearing a lot about artificial intelligence and like any other sector within the economy, healthcare is also seeing the impact of AI.

And I spent a lot of my time thinking about the applications of AI to healthcare and trying to understand what are the most urgent problems to be solved and what are the most urgent problems that are the best fit for the technologies of today.

And we will continue to do that for the foreseeable future. I think that's unavoidable.

So those are some of the areas I'm excited about and looking forward to seeing how they change the future of healthcare.

Chris Madden:
But AI is not a replacement for compassion, intuition, or human connection. The teams that succeed will be the ones who balance innovation with empathy.

I like how Joanna understood the difference of utilizing AI to help ease work burdens, but still keeping that human connection.

Joanna Strober:
We will always be a care company and we will always have NPs listening to you.

We are not trying to take away the people and replace them with AI. We're only interested in supplementing them with AI, and that is, that's really important.

That is, I don't believe you can take away the human connection, and I don't believe that AI is going to do that. But it can make sure that we provide incredibly high quality care and that I am delighted to be using for that purpose.

Chris Madden:
One of my favorite talking points from this season, Ankit’s North Star. Successful companies are pulled forward by something bigger than revenue. That clarity is what helps companies make the right decisions when things get messy, complicated, or uncertain.

Ankit Gupta:
We're really motivated by our North Star, which is opioid use disorder for all.

So I see us in the next few years being able to really step into that wholeheartedly. Any state, any health plan, any acuity level, Bicycle Health should be able to help you get treatment.

We're really expanding our Medicaid coverage and working with Medicaid managed care plans across the country to be able to do that.

We're building a lot of partnerships with local providers of opioid use disorder treatment, especially in states where a purely telehealth model might not be feasible.

We are really investing in the criminal justice part of the business and really building those partnerships with jails and prisons and departments of corrections and parole and the entire ecosystem, along with counties and EMS.

And so really bringing these parties together to be able to get to a point where if someone has an opioid use disorder, they can get treatment maybe through the providers that Bicycle Health has, or maybe through partners in the community.

I think in the long term, this could definitely grow into a larger behavioral health platform because of a lot of the stuff we have figured out reaching patients, engaging health plans, operations to actually provide care.

I think we can go beyond opioid use disorder to a broader behavioral health platform, not for everyone, but for a specific kind of patient population that is highly underserved and that's the ultimate vision.

But for now, we're really focused on how do we get to a place where we can provide opioid use disorder for all.

Chris Madden:
Digital health and telehealth specifically is reshaping what's possible. Not just in clinics, but in criminal justice, behavioral health, and recovery support.

The way Ankit talks about innovation inside prisons and correctional settings is something that most people don't think about, but that's where digital health can create a life-changing impact.

Everybody deserves someone fighting for their care, and technology can finally make that a reality.

Ankit Gupta:
So I'm actually really excited about, it's funny to say, innovation in the criminal justice context, but innovation that is happening in the criminal justice system.

There's a realization that opioid addiction and broadly behavioral health is a huge need, and especially when it comes to MOUD treatment.

I'm seeing lots of facilities actually find the funding, either through grants or through state budgets to start new patients into treatment, to start initiating patients into treatment inside the jails.

And why that is really powerful is because almost 2 million people go through the criminal justice system who have opioid use disorder, and that's a perfect time for them to be in the mindset of making a change.

And so if we are able to start treatment inside the walls, continue that seamlessly outside the walls, and telehealth to do that, then we actually have an engine that can help us turn around the opioid epidemic and have a pretty big lever to pull to be able to do that.

So I'm really excited about that. I'm also really excited about GLP-1 and the impact they could have on addiction, although the studies are ongoing. But yeah, there's a lot to look forward to.

Chris Madden:
Thank you so much for following along our journey this season. We've covered marketing tactics, compliance, creative testing, team building, AI, patient behavior, and now the impact digital health is having at scale.

So I'll leave you with one question. How has digital health impacted your life? Whether booking a virtual doctor's appointment, to seeing an ad that nudges you toward care you've been putting off, to finally getting the support you deserve.

Digital health isn't the future. It's the present, and I hope this season helped you understand it, navigate it, and feel empowered by it.

Here's to our health.

Chris Madden:
If you've ever tried to build a marketing team in digital health, you know it's not like hiring for any other industry. You're building in a regulated environment. You're juggling revenue pressure, patient outcomes, compliance constraints, and a buyer that's historically slow to move. And yet the teams that crack this code, they can unlock growth fast.

This is Marketing Digital Health, and I'm your host, Chris Madden. Today's episode is all about understanding what that actually takes, the talent, the structure, the culture, and the process behind high performing digital health marketing teams. We're talking with people who live this every day. Leaders who've built teams from scratch, navigated hypergrowth and figured out how to scale execution without losing quality.

And we're starting with someone who's had a front row seat to all of it. Norm Volsky leads the digital health practice at Direct Recruiters, hiring senior leaders and full marketing organizations for payers, providers, virtual first care, health tech, and life sciences. He specializes in org design, executive search, and go to market hiring in regulated high growth environments, helping companies match stage appropriate talent with the realities of healthcare.

In addition to his role at Direct Recruiters, Norm is a founding partner at MVP Growth Partners, an investment and advisory group that empowers visionary entrepreneurs and innovators to bend the cost curve of US healthcare. MVP Growth Partners provides strategic investment, operational guidance, and a collaborative network focused on measurable clinical and financial outcomes.

The firm is grounded in integrity, collective intelligence, and founder collaboration, driving sustainable growth through disciplined evaluation, hands on support and aligned incentives. Norm is also the host of the Digital Health Heavyweights podcast, where he interviews leading founders, investors, and executives shaping the health of healthcare technology.

Norm Volsky:
Success is addicting, and I think when people experience success and achievement in their career, they just want more of it, and they wanna feel that again. And when the best talent feels like they're stagnant, they're not growing, their company's not growing, they're not winning. They wanna get that feeling of winning again.

So I would say in general, that is like the core of all things motivation. When great talent feels like they're not winning anymore, that's usually when they're open at picking their head up and considering getting themselves in a situation where they're set up to win better.

I hate to say it as a Cleveland fan. When LeBron went to Miami, he made the move because essentially he wasn't winning up to his expectation. Maybe he didn't handle it the perfect way and making the whole world know that Cleveland wasn't cutting it for him at the time. But same thing that motivated him to go pursue titles in Miami mid career is the same thing that motivates top talent in every market to move on and go to what they perceive as greener pastures.

Chris Madden:
From a digital health standpoint, Norm gives us such a clear view into what candidates actually want and what companies need in order to attract them. Modern talent doesn't want stagnation. They want momentum. They wanna feel the company is moving with purpose.

In my experience, the people who thrive in this space are the ones energized by growth and Norm’s seeing the same patterns across the market.

Norm Volsky:
What I look for and what a lot of talent looks for is mission driven. It's number one. If a company is not mission driven and in the business for the right reasons, it becomes very clear pretty quickly that incentives are misaligned.

Another thing that is incredibly crucial in our market is that the CEO of the company has a direct experience with whatever problem they're solving. I would argue they probably have to be a world renowned expert in that specific category to have any amount of success. If you don't come into a room of educated people and are able to become an authority on that subject, you're most likely not gonna have a ton of success.

Mission driven and the CEO being an expert and a true authority on that topic is gonna be a really important thing to start. But what else needs to be in place for it to truly become a destination and beacon for talent?

First, they have to be solving a real problem that customers are experiencing issues in. So I think there has to be product market fit, and not only that it's an issue, but it's measurable and there's a measurable impact post implementation. A hard ROI, a cost savings component, specifically in the employee benefits space is an extremely important characteristic.

Now I know plenty of top sellers that say, hey, I don't care who the company is, if they don't have a hard ROI and they can't prove cost savings, could be the best company since sliced bread, I don't think they're gonna have as much success as they're capable of without those components. So I would say those are the biggies.

Another thing is, are they not only a destination for talent, but can they keep that talent happy? A lot of companies at the early onset, when they're trying to establish themselves, when they're trying to build a brand, they may recruit the best of the best and be willing to pay the best of the best and really do what it takes to get them into the organization.

But what does that company do a year, two years, three years later, after they've experienced tremendous success? Does that success get to the executives, the founders, even the investors’ head and say, well, we don't need top talent. We're Walmart, we're Coca-Cola. We're like the name brand in our space. Now we just need average talent. And why pay these people an arm and a leg going forward?

Because now it's easy to sell or it's easy to market the solution, or it's easy to whatever the company is doing and whatever they potentially need from a talent standpoint.

But I think the smart companies are the ones that say, hey, we don't get here without the talent and we're not gonna get to the next level if we don't keep that talent happy and continue to promote that group of people that helped us get here, give them more equity, give them more career upside, because again, as soon as that talent feels, hey, I'm stagnant, I'm not growing, that's the exact moment at which they start to open their eyes and see what their alternatives are.

Chris Madden:
There are a few roles in digital health that always stay in high demand, and Norm breaks down something I hear from founders continuously. They want people who can either save money or make money.

It's a reminder that as teams scale, the early hires aren't just filling seats, they're driving the entire direction of the business.

Norm Volsky:
Financial leadership has been very in vogue. The person on our team that does all finance search, career year after career year.

Sales as well. Top sellers are always in demand and commercial leaders always in demand.

What I'm starting to see open up more than has been in the last couple years is some of the other things we used to do a ton of that were a little lighter in the last couple years. We're seeing product management come back in full swing. We're seeing marketing come back. We're seeing customer success being emphasized more than it's been emphasized in the last couple of years.

Engineering and tech talent, although always in demand, I'm starting to see even more demand there than there's been in the past.

So important for you to know when I'm talking about talent. Our team does everything from sales to partnerships and business development and corp dev, marketing, product, ops, account management, customer success, client services, product, tech, engineering, finance and legal.

Our core competencies might have missed a position type here or there, but usually it kind of funnels into those major areas of expertise. And we probably do about 80 to 90 percent of what most of our clients need. And then if something's out of scope, we usually get others involved because again, in our business, I would argue niche specialty can really achieve drastically different results.

So if there's a client of ours that needs something that doesn't fall within our niche specialty, which is health and benefits, we don't touch it because it's not good use of our time. It's not a good use of their resources, for us to be learning on the job.

Chris Madden:
When you're building a team, knowing what's not right for you is just as important as knowing what is. A key takeaway here is honesty, being able to say no to a search because the candidate pool is not aligned.

Norm Volsky:
I talked to a CEO of a company that's growing like a weed. And he needs several things. One of the things he needs is COO, which we place tons of COOs, but he said, interestingly, for this one, I really need someone a little bit more from direct to consumer, maybe manufacturing.

And I said, hey, that sounds like an amazing role for the right team. That's actually not for us. That's actually not the candidate pool we have immediate access to. And I don't have a list of dozens, if not even over a hundred people, that we can go out and go get the best people with that skill set. So I'm gonna pass on that one because I don't wanna set the wrong expectation. I don't want you to evaluate us based on our ability to accomplish that search as it's outside of scope.

Chris Madden:
Switching gears, Norm breaks down something that I also see in digital health. There are mission driven founders and then there are follow the money founders. Both exist, but only one group builds organizations that people genuinely want to work for.

It's a helpful lens for understanding how teams form and why some teams thrive while others have turnover continuously.

Norm Volsky:
Every healthcare company is going to tell you they're mission driven. With that being said, I think there's two types of founders.

There are founders that experience an issue in their own personal lives that think to themselves, I'm not the only one suffering from this issue. And if I solved it at scale, not only could it be financially beneficial, but that's what I wanna spend my life doing and that's what I wanna spend my time fixing.

And then there's founders that look for the problem that comes with dollar signs. This government regulation is going to mean this market is going to be very, very hot and there's gonna be a lot of commercial traction, and I'm following the dollar signs, and I'll figure out a way to concoct some sort of storytelling that makes me seem mission driven. And this came from the problem, not the end result being the motivation of starting this company.

That ball unravels very quickly if you not only start to dig in a little, but you also see how the company operates.

So again, I'm not picking anyone out, I'm not gonna mention any names, but a good example is the GLP-1 space. There are a lot of companies that have all gone into GLP-1s.

I think some of those founders might have personally dealt with that as a clinician, as a patient. And before it became very in vogue and very popular in pop culture and obviously dollar signs going with that, built a business prior to it being one of the most hotly discussed markets within employee health benefits.

And then there are some that just follow the dollars. Hey, GLP-1s, weight loss, and it's gonna be an area where there's gonna be a lot of prescriptions and a lot of care management. Oh, let me build a company because if we can even win X percent of market share, we're gonna have a business doing X run rate in revenue, and then we can sell it for Y.

That's a very different motivation for coming in work Monday through Friday, getting people to get excited to come and work their butts off even when you know you have some rejection or have some stumbling blocks.

It can really separate the people doing it because it's what they wanna be doing, and it's what their passions are, and whether it's, hey, this is a business with the intent to make money.

Chris Madden:
Chris Ritson is a growth advisor for digital health companies and is the founder of Single Aim Marketing. We introduced Chris in episode one around why marketing digital health matters.

He's a founder, but he's also someone who's navigated both high growth consumer technology and healthcare. And when you've worked inside those two worlds, you can see patterns differently.

He started off as an app developer on the Facebook team building viral Facebook apps back in 08 and 09. Then he sought to do something more tangible and made the move to healthcare. Chris brings a perspective that merges rigor with creativity, and that's what makes his take on team building so valuable.

Chris Turitzin:
I was at Facebook for a handful of years on the growth team at Facebook, where I guess I grew up quickly. I had never really learned what growth meant from a rigorous perspective and trial by fire there.

I spent a handful of years at Facebook, and then in 2014 made like a hard pivot, had been in this consumer internet world, but wanted to do something that felt more tangible, felt more in a real world, but also felt like an area that I could basically spend like decades going deeper and deeper in, and healthcare fit the bill pretty well at that point.

And so I jumped into healthcare with essentially no experience, and I've always had this life of one foot in the kind of consumer growth world and one foot in a highly regulated, highly constrained healthcare world, which can be quite awkward at times and sometimes feel like not a great fit, but I've always maintained that I think that is like a really interesting niche to be in.

And it provides you a unique perspective that a lot of folks that either come from one world or the other don't have. So in my time in the healthcare world, the last 10 years, primarily worked on three things. First was Virta Health, which is a digital provider organization focusing on diabetes reversal.

And then right at the beginning of the pandemic, I had been working with Bicycle Health. It was a very nascent organization, jumped in to help the founder grow that. We grew it from a few hundred patients to tens of thousands of patients over a handful of years, and then rolled off Bicycle about a year ago, started a company called Single Aim, which is focused on individual entrepreneurship for clinicians such as nurse practitioners and physicians assistants.

So we have a lot of interesting products in the pipeline there, and my general hypothesis right now is that this area of clinician entrepreneurship is gonna be like a next big wave. I also work with a handful of digital health companies in various parts of the marketing stack, either providers themselves or organizations that work with digital health companies on an advisor relationship.

Chris Madden:
As a successful founder, Chris is always scanning the landscape, looking at where the next wave of growth might come from. He's seen firsthand how clinician entrepreneurship is shaping new models of care, and those trends directly influence how teams need to be built.

It's one of those areas where the market forces and the talent pipeline move together.

Chris Turitzin:
There's actually interesting narratives going on here, because if you look at physician entrepreneurship, it's essentially only gone down in the last, I don't know, 60 years. I think the numbers used to be something like 40 percent of physicians ran their own practices, now it's down to 10 percent.

But if you look at the rates for these nurse practitioners and physicians assistants, it's going in the opposite direction. So the rates of entrepreneurship, they're very small numbers, but from the best data I can find, it's going from 1 percent a few years ago are entrepreneurs to now two, three, 4 percent are entrepreneurial. So in investing, four X-ing in a matter of years, which is very quick growth, even though it is a small total.

And also the size of the population of nurse practitioners and physicians assistants is growing quite quickly. I think there's some projections, I don't know the year, I think I heard maybe like 2031, there's actually gonna be more PAs and NPs than there are physicians in the country.

There's also just generally a need for more clinicians, especially in many areas that have less access. I think also at some point clinicians are gonna reach a breaking point. I think it's already happened where the employment model, the corporate employment model just is too difficult for people to enjoy their jobs on a daily basis. So there's a lot of just latent pressure to get out of that and do other things.

And you see that among nurses, among NPs, also among physicians. And then you see things, for example, the burgeoning amount of people starting med spas, the amount of people going to work on platforms like Headway. So there's just a lot of energy there.

Chris Madden:
Founders with lived experience often build teams with a stronger sense of purpose. It's a reminder that culture isn't something you write down. It's something you model.

Ben Riggs is a writer and content manager at Kettering Health. We introduced Ben in episode four around storytelling and trust. Another great example of someone who's connected their personal story to their career path, and you can hear how much that matters.

Ben Riggs:
I have the benefit of working myself and working with a team of people who are sitting down with physicians who are sharing their expertise on hydration, on heart health, on what, infinite number of topics, but also sitting with patients who have honestly really come away with powerful experiences that while they are changed for the better from a recovery standpoint, their worldview has also changed because of perhaps the extra mile, the compassion, the expertise that a care team provided.

I'll be honest, I probably drink more water because of having worked on X number of pieces about hydration and its impacts. I actually, I won a trivia question one time with a group of friends about hydration and its impacts, or not. But two, it would be a shame for someone to work on consumer health pieces and not walk away wanting to apply some of them to their everyday life.

There have been moments where, because of patient stories in my personal life, I've gotten to know that I feel really good about working here, and I feel really good about contributing to content here because I know that we are following through on our mission. We are following through on our promise to patients.

And we have some really incredible people here doing some really incredible work. And so I think that personally, some of them are my friends now, some of these physicians, and so getting to know them and know that they mean business, they really take patient care, patient safety very seriously and they're doing a really good job of it.

And so I think that just personally, I don't have many qualms waking up and working for Kettering Health, largely because of the people I get to work with, but also the people that I know who are caring for our patients and having gotten to work with them. And that's great for your mental health.

Chris Madden:
Norm brings us back to leadership, the cornerstone of any strong team. I've seen companies with great products fall apart because the executive team didn't value talent. And I've seen companies win because the CEO understood how much the right team can change everything.

It really does start at the top.

Norm Volsky:
A key to companies succeeding and becoming a beacon of talent is it has to start at the top. If the CEO doesn't feel that they need help and they need a great team around them to succeed, I would run. I would be very scared.

If a founder thinks with mediocre talent around them, they're still gonna be able to succeed, and that is a core belief that doesn't typically change as someone has more success, it only emboldens their thinking. As they achieve more success, like, oh, I'm the reason. I don't need help. I don't need support. I don't need a team around me, like all that kind of stuff.

So I think it's really important in a talent organization internally or externally that you understand and have a good feeling for, does the CEO and the founding team, do they value talent and at which interval they value talent and is that a moment in time or is that a philosophy long term about how they do their business, how they run business?

And same thing on the talent side. If you're getting a great experience from the talent team, but the executives aren't giving you the time of day, that's probably an indication of how you'll be treated as a full time employee.

I would also argue if you're working with a company during an interview process and their executives are rolling out the red carpet and really being intentional about making a great impression and taking the time to take you to lunch or take you to dinner or finding extra time and maybe hanging out with you socially, getting to meet your spouse or your kids.

Those things are incredibly important and very telling of what the company culture will be. So I would just say in most things in business, it starts at the top, and if CEO and founders aren't prioritizing something, usually that's not gonna bode well long term for whatever that area you're looking to prioritize is.

Chris Madden:
When it comes to building a high performing team, Norm names a critical combination, high confidence and low ego. Digital health moves fast and early stage companies need leaders who aren't afraid to roll up their sleeves.

That combination is exactly what scaling companies need.

Norm Volsky:
When I think about growth stage hiring, I'm thinking about companies founder led, probably their founder did most of their first handful of sales, and at the point I'm meeting them, they might need to scale their company and hire people to do certain tasks in certain position verticals that they don't necessarily have all the time in the day for anymore.

When I'm thinking about that, it's like, all right, let's hire a Chief Commercial, Chief Operating, Chief Financial Officer, CTO, and surround the founder with a strong team. What I think is crucial is you look for people with a lot of confidence, but low ego, and the reason for that is in a very early stage company, there are not a ton of resources. There are not a ton of employees.

So you could have a C level title, you could be getting paid extremely well. You could already have been ultra successful in other career steps and maybe even be very financially well off from some of that previous success. But when push comes to shove, something needs to get done. A lot of times you have to look in the mirror and say, okay, I'm gonna have to do that myself, because there isn't anyone to delegate it to, or that's not a resource I can pull on within the company right now.

So I think what's really important for scaling companies is getting really good talent, but you have to make sure they're willing to do the work and roll up the sleeves. So many times I see people who get hired in a situation with a growing company that is not really ready to do the work. It's been a very long time since they were boots on the ground and like very customer facing, and within a couple months they realized I was not prepared for what I signed up for.

And when they meet with their executives and founders and investors, they start to say, well, for me to be able to accomplish this, I really need to hire this person. And all of a sudden this company's burning money because the person they intended to hire to not only lead commercial, but also do some selling, or not only to lead technology, but also do some development and programming, or run operations, but not necessarily roll the sleeves and do any of the operations work, marketing, so on and so forth.

That's when you start to bleed money and not make a ton of progress. So I think it's really important when you're hiring for growth stage companies that you're looking for people who are very accomplished, but still willing to do the work and have a low ego level where they're not too comfortable. You know that they're actually willing to do some of the less desirable tasks a company needs to do, because sometimes when you're CEO, you gotta take out the trash.

Chris Madden:
Another key takeaway, set expectations correctly at the hiring stage, whether you're hiring junior talent with upward potential or senior leaders willing to get their hands dirty. Clarity prevents so much misalignment down the line.

It's one of the simplest ways to protect your culture as you grow.

Norm Volsky:
There's no one way to slice it. I've seen companies hire external agencies and use them for over a decade. I've seen people hire a very junior marketer that becomes the CMO of a company because they continue to get more and more responsibility. They consistently hit objectives and they just earn promotion after promotion.

What I do think is very important was about combination of succession planning and hiring in the right order, I think was like the general gist, and what I would say is it can be done anyway. You can hire junior with the intent to promote. You can hire a senior with the expectation that you're rolling up the sleeves until the team and revenue's big enough to justify you having a team.

What's incredibly important is you set proper expectations, because what cannot happen is you hire a young person or less experienced person with the intent that they're gonna grow into the role and not make very clear, here's what is expected, and if you're not accomplishing these things by this date.

Yes, the plan is to promote you all the way through the organization, and nothing's stopping you from being eventually the Chief Marketing Officer, but you need to do this and this to get there, and if we don't, we have the right to hire above you if at any point you're not able to grow into the role.

Same thing with what we described earlier. You hire a Chief Marketing Officer that's led a team of 50 people, they're willing to roll up sleeves, but explaining like, hey, I'm glad you're willing to roll up the sleeves, but at what time point in the future are you gonna say, hey, I'm getting a little fatigued, I need to hire a team.

Here are the things and the mile markers we have pre agreed upon, that until we accomplish X, Y, Z, you can't hire more people. And that way people see what the light at the end of the tunnel is, and then make an informed decision of, okay, having done this before, yeah, knowing that it usually takes, let's say, eight to 16 months for us to accomplish that, I'm willing to sign up for a year and a half or less of rolling up the sleeves until I'm able to make that hire.

So I think, again, there's a lot of best practices that we can follow. But I think a core competency and a core value that's really important in the recruiting is just setting proper expectations. Don't commit to things you're not fully willing to live by in the future, and that works on both sides.

Chris Madden:
Norm also talks about the traits he looks for in top marketing talent, creativity, communication, empathy and organizational strength.

And he's right. Digital health marketers need to understand human behavior at a deep level. They're not just selling a product, they're helping people navigate their health, often during vulnerable moments.

Norm Volsky:
We like creativity, we need to see that. I do think organization is important, having a well thought out strategy and not just someone that's creative but doesn't know how to harness that creativity.

And I believe they have to be excellent communicators and I think they have to be very empathetic, because when it really comes down to it, what is marketing's job? Their job is to understand the buyer and understand how to position the product to give itself the most chance, or its highest probability of being considered as a solution that buyer will buy at some point in the future.

So being really perceptive, understanding human behavior is a very, very important thing, specifically within digital health, because not only do you need to be able to market to the buyer, but a lot of these contracts are performance based. Unless they're getting engagement, utilization, they don't make any money.

So for example, MIDI, you know, a company in the menopause space, they can sell large health plan, they can sell Anthem tomorrow. If none of the Anthem members use it, MIDI makes zero.

So not only does a marketing leader at a company like MIDI have to market its services to its end buyer, which could be health plan, could be employer, could be health system, you name it, but they also have to have the function of not only B2B marketing, but also B2B2C, because they need to get the engagement, they need to get people to actually adopt the solution. Some companies need them to download the app or opt into a program.

So I think that's what's unique about digital health for these marketing leaders. They need to know B2B and B2B2C really, really well because both are crucial to having success.

Chris Madden:
Brian Davidson is my co founder at Matchnode. We first introduced Brian in episode seven when he contributed to the overview of the paid acquisition funnel in digital health.

Brian is someone who embodies what Norm is describing. A leader who uses research, creativity, and structured testing to scale companies responsibly. A strong marketing team doesn't just guess. They listen, learn, and experiment their way into growth, always grounded in data.

Brian Davidson:
So usually businesses come to us when they're looking at scale. They've already proven out to some degree that their offering is working, that there's a marketplace for it, that they're able to help patients or validate that their product is working or their service is working, and people come to us saying, this is great.

I've got these channels that are working. Some people are finding us organically. Email marketing might be working, or we've got something going with direct mail. Can we start to scale this using paid channels?

And generally speaking in business in general, paid channels is really where you begin to scale your business.

Chris Madden:
At Matchnode, we utilize research and ideas to help.

Brian Davidson:
Generating the idea, yeah, well generally that's a lot of time talking to the client. That's a lot of research on either their part or our part or a combination of both.

There's definitely these days an AI element of just trying to get more ideas and then iterate on those AI generated ideas and really try to come up with a very large laundry list of different ideas you can test.

And sometimes I like to get some outlier ideas, those things that seem outlandish at first or seem a little bit crazy and are a big departure from what the company's doing right now, because sometimes you need a big test to learn something really, really important.

Chris Madden:
Motivation is a huge factor in building high performing teams, and Norm shares something important. Great talent isn't just chasing a job. They're chasing the right environment, one that aligns with how they work and what they value.

And when you understand someone's true motivation, you can hire better, you build better, and you retain people longer.

Norm Volsky:
Number one is listen. It is very easy in a hiring seat, whether you're a recruiter, hiring manager, to hope that someone in front of you is everything you hope they to be, because that's convenient, like you hope that the person you're talking to can solve all your problems, because then you've saved a ton of time and effort.

So I think it's really important that you listen really well onto why someone's open to making a move, what motivates them, what environment they like working in, why they like working in that environment, what personality types they like working with, what type of personality types they don't, and really understanding past experience, what baggage do they have, good and bad.

All of that context, we do not pitch clients before we understand the candidate's experience and their motivations because number one, we don't wanna waste our own time. Number two, we don't wanna waste the candidate's time.

And otherwise we end up having the same conversation dozen plus times a year of, oh, let me tell you what I'm working on. That's new. Pitch regurgitate. Okay, what do you think? And if we don't understand what that person's experience is, what motivates them, what their current situation is, what a better one would look like, we're literally just throwing darts at a dartboard with our eyes closed.

So I think it's really important to truly listen and to understand what the perfect situation is for that person you're talking to, and being very honest with not only them, but also yourself. Is the situation you're describing, is it what they're looking for or is it just your convenient situation that like they have the experience that would allow them to be successful in it, might not be exactly what they're looking for or even be deemed enjoyable by them.

So I think it's just always looking at it from, is it in their best interest to pursue it? And if not, just cut the cord, because credibility is the most important thing in this business. If you don't have people's trust, you have nothing.

Chris Madden:
AI is inescapable. So I asked Norm his thoughts when it comes to AI in the hiring process. Is it possible that AI will take over or is it just working alongside us and helping us speed up processes?

Norm Volsky:
I personally believe that persuasion is a personal task, like a human task. I don't know if AI will be able to persuade in the same way humans can, because AI lacks empathy. It's not a human. It's hard for AI to screen for those types of things.

So I focus on keeping my team customer or candidate facing as much of the day as possible, and we are leveraging AI to do that. The task of writing up a candidate and presenting them to a client is a lot faster now, because you can leverage AI, you can write something up in a minute that would've taken 30 minutes before.

There's plenty of AI to make sure the candidate tracking and the client communication is all done super seamlessly. But I'm not a fan of taking away the personal touch and using AI that is either customer or candidate facing.

So I think it's made us more efficient and allowed us to spend more time building relationships, but we don't leverage AI as a replacement for the human touch.

Chris Madden:
Something that's always stuck with Norm is the idea of leaving your ego at the door. He learned this from founders like Glen Talman at Livongo. In addition, these successful founders have mission driven goals.

Norm Volsky:
Another thing to keep in mind when doing recruiting is you gotta have a really small ego and you've gotta be willing to put your ego aside in a lot of situations. And even when people initially say no, sometimes, not every time, but sometimes, with the right level of caring and information and time spent with a senior executive in the company, they can change people's minds, because they're willing to be rejected. They're willing to fail. They're willing to put themselves out there.

Another thing to think about when you're thinking about building teams, especially in the early years, it eventually will get easier. When I started recruiting for Hinge Health or Livongo, I was educating people that they even existed. They weren't companies that were brand names yet. As they became brand name, they were able to recruit talent at a different level and a lot easier, sometimes not even needing my services later in our relationship, less and less.

But what those founders did really, really well, and Glen in particular because he had a couple wins on his resume before starting Livongo, that, hey, you gotta bend over backwards and you gotta roll out the red carpet, even if you feel you don't have to.

Let me explain why I think Glen at Livongo was so uber successful and why Dan and Gabriel at Hinge were ultra successful. And David Ebersman at Lira, and I can go on and on, Sammy and can then Alberta, and the list goes on and on.

But what I would say about these folks is there was a mission driven component to it, and their lives were personally touched by the conditions that they are helping manage. So Glen, whose diabetes management company, his son had diabetes. So he as a parent saw how hard and difficult it was to manage diabetes for an individual.

And he said, you know what, our family can't be the only one going through this. And I don't want any family to struggle with it, especially my own. So if I'm gonna solve this problem for my family, I might as well solve it for the entire country.

That's how Glen thinks. That's how he builds amazing businesses.

Dan Perez and Gabriel, Dan fell off his bike in, I believe, middle school, broke his arm and it really was a traumatic experience for him, and recovering from that musculoskeletal injury was something that had a deep, profound impact on his life.

His co founder Gabriel was a judo enthusiast that tore his ACL in judo and also had a PT recovery story as well. And they wanted to give people access to something they didn't have access to, which was remote physical therapy and the ability to do it in the comfort of their own home.

David Ebersman had a family member that was going through some mental health challenges. Even he, who was at the time CFO of Facebook, had every resource imaginable at his disposal, couldn't get one of his family members in to see the right type of therapist for months, maybe even over a year, and said, you know what, I should probably build a company that allows people to access mental healthcare in an easier way than currently exists in the healthcare market.

All of them had an issue that they dealt with personally, or someone they cared about dealt with it, and then they solved it for the masses. They didn't say, oh, the United States is in a diabetes epidemic or mental health epidemic, let me figure out how to monetize this. It was more of, let me solve a micro issue and then do it at scale.

So I think, again, that really ties into the mission driven nature. When it's about more than dollars and cents, it's really easy for employees to see that.

Chris Madden:
As we've seen in this episode, great teams don't happen by accident. They're built with intention through hiring, culture, leadership, and an honest understanding of what the business needs.

The companies that win in digital health aren't just the ones with great products. They're the ones with great people. People who stay curious, collaborate, and stay grounded in the mission of improving care. And if you want to scale and not just grow, but truly scale, building the right team is the most strategic move you can make.

Finally, we'll pull the threads together. Our next episode, episode 24, offers reflections as well as a forward look at what digital health marketing means for the future of care and where we can go from here.

Chris Madden:
Founders in digital health all have two things in common. First, they care deeply and second, they jump in before the map is fully drawn. They’re building companies while navigating uncertainty, changing regulations, shifting patient needs, and a whole lot of trial and error. This is Marketing Digital Health, and I’m your host, Chris Madden.

Today we’re bringing together three founders who didn’t just build companies, they built solutions to problems that they lived or witnessed firsthand. You’ll hear the early decisions, the “we had no idea what we were doing” moments, and the pivots that shaped everything after. Ankit Gupta, Joanna Strober and Jessica Holton each take us back to day zero, how their ideas formed, why they pushed forward, and what they learned along the way.

Let’s get into it. We introduced Ankit Gupta in episode 16 on navigating state level fragmentation.

Ankit Gupta:
We are a national virtual treatment provider for opioid addiction, so we help people who are addicted to opioids who are looking to get off opioids and really enter recovery and make a long term change in their life. We provide a comprehensive treatment model, which includes medications, therapy, recovery coaching, case management, really a holistic kind of wraparound model that patient can engage in slowly through the app on the phone, across almost all 50 states across the country.

Chris Madden:
Behind every great founder is a moment, sometimes more than one moment, sometimes a string of them, that pushes them to solve a problem that they can no longer ignore. For Ankit, that spark started long before Bicycle Health existed, and it came from seeing the gaps up close. He’s one of those founders who mixes technical talent with curiosity, and that combination led him somewhere he didn’t expect.

Ankit Gupta:
What drove me to even think about healthcare and what I want to do next. I come from the tech world. I’m a software engineer by training. My last company was a mobile app called Pulse News, which we ran for a few years and it got acquired by LinkedIn and is now called the LinkedIn newsfeed.

And so as I was transitioning out of LinkedIn and I wanted to think about what I want to do next, where I want to spend my time, I knew I wanted to do something that’s a lot more impact oriented. I wanted to help people in some way. And I happened to get married to a doctor during that journey, just knowing or noting the patients she’s seeing and how many people with addiction and behavioral health issues walked through the hospital.

And she’s not someone who has any particular training in this field, but it’s just so highly pervasive. And so that led me to start talking to people in recovery, start hearing the story, and I was just blown away by how many people I knew and I didn’t know that they were in recovery or had these journeys or had close friends and family members having gone through these journeys, and all of those stories kept coming up for me and it was clear that our healthcare system is all obviously super fragmented in the US, but especially when it comes to addiction and recovery and behavioral health, it’s even worse.

And so many issues that people brought up around not being able to access treatment, doctors not being available nearby, insurance is really hard to navigate. It’s hard to take both treatment and work and family responsibilities all together. It was just one barrier after another, and in my brain, it seemed like technology can really help overcome a lot of those and make treatment really streamlined, really accessible, really pure, confidential, really convenient, user friendly.

And that’s something that really excited me to explore more.

Chris Madden:
One trait I see again and again with founders, they’re willing to explore and be curious. They’re willing to chase a question before they know what the answer might be.

Ankit Gupta:
I am not a healthcare person, I guess, or have no understanding of healthcare or really understanding of how services work, and so I stumbled a lot along the way, but one of the very first things in hindsight I was just so fortunate is, I had a friend who knew someone who was retiring and they had a small addiction practice here in Redwood City in California.

They just needed someone to run for, and it was one provider, a few hundred patients. It was pretty small, a small office, and for me that seemed like a great opportunity to dip my foot into healthcare and so I ended up acquiring the practice. I was living in Boston at the time, and the practice was here in California.

And so it naturally made it necessary for us to use a lot of technology to both run our operations as well as for me to really run the practice. Through that, I started learning more about the patient population, talking to patient, learning more about clinical practice, the technology challenges, and starting to improve things.

I also learned a lot about how do you really reach patients in the community, how do you actually work with insurance, get treatment reimbursed. And over about 12 to 18 months, we got the practice to be cash flow positive, sustainable, got insurance contracts, really deployed a lot of kind of modern technology into the medical operation.

And that was a nice hobby just for me to try some ideas out. And then COVID hit and it forced us to move everything remote. So move away from brick and mortar, have our provider work from home, have patients be seen online. And we didn’t have any apps or any fancy technology back then, but we basically cobbled together all the tools that a small operation that not a lot of money could buy.

And just started trying out what a purely telehealth model. And we also opened our doors up to the entire state of California because we could, because of the regulations. And that’s when it really struck me in like a visceral way. The demand for our service almost melted down our servers. The demand was so overwhelming as we opened ourselves up to the entire state of California, and even the patient and provider experience was so much better by everything being on telemedicine, providers work from home, and so just felt like we had unlocked a new model that really could be furthered and expanded upon in this unique environment, everyone was locked in home in a unique setting.

And so I think having had that background of raising money, having a purely technology company that I did before, it felt very familiar to me that this is now a technology solution that we can really raise venture capital for and really grow and expand nationally in the same way that I would for any other tech business, even though it was a clinic initially that we were running.

Chris Madden:
Joanna Strober is the founder and CEO of Midi Health. We introduced Joanna in episode 1 around why marketing digital health matters. For her, the story started somewhere deeply personal. It wasn’t a market analysis or a pitch deck, it was her own health journey and the feelings so many people can relate to. Why did it take this long to find the right care?

Joanna Strober:
Founding stories are complicated, right, because they’re never quite the straight line that you might read. But for Midi, it really did start with my perimenopause symptoms I was experiencing. All the symptoms of perimenopause: brain fog, lots of lack of sleep, the waking up in the middle of the night, I was having hot flashes throughout the day, really a lot of mood issues, and because I was still having my period, no one diagnosed this as perimenopause.

So I went to a sleep specialist to figure out why I was waking up in the middle of the night and not sleeping. I went to a primary care doctor to figure out anxiety. They gave me SSRIs medication and told me to go to therapy. So for about a year, I was really given the wrong care. Eventually, I was told, maybe this is a hormone issue.

When I drove to San Francisco, when I paid a thousand dollars to a hormone specialist and she gave me new medications. Literally within weeks, all of my issues had gone away. I was back to me, I was back to my old self. And my family noticed. My spouse noticed, and it made a big impact at work. And I have a lot of sadness about how long it took me for me to get this right care.

So I started thinking why that is and is there a way to fix that? And eventually what I realized was that because the COVID laws had changed healthcare, you now for the first time could create a national menopause clinic with care covered by insurance. So we could take that expertise of the woman that I went to in San Francisco who really knew how to take care of women in perimenopause and menopause, and we could extend her care to women nationwide and get that covered by insurance.

That’s when the light bulb went off and I was like, ah, this should be a company.

Chris Madden:
Midi Health wasn’t the first company Joanna started. One of her greatest strengths is seeing a problem and then taking action. Kurbo, an app based weight management program for children and teens, was built on that instinct.

Joanna Strober:
We started Kurbo in 2014 because we saw a number of adult weight loss companies getting started, and it was pretty clear that technology was gonna be a big help in helping adults lose weight, whether with apps to track your calories, with online coaching. And no one was doing the same thing for children.

And childhood obesity is a huge problem in this country. 40 percent of children are overweight or obese, and the idea was to build something to help them. So we actually did, and I was insanely proud of that. We were able to build an app that was safe for kids, that helped them to learn healthy habits, and we were able to get Medicaid to actually cover it in a number of states.

What was super hard is that Medicaid would pay for it, but it was actually hard to reach those children for a lot of reasons that maybe as technology gets better would get solved. But we found that Medicaid kids were the most needy of this, but it was very hard to reach them, and commercial plans were not willing to pay for it because, again, this is before COVID and before telehealth was covered as something that was insurance covered, so we couldn’t get commercial plans to pay for it.

So we ended up selling to Weight Watchers. I was really happy with the outcome, but the learnings that I had were number one: insurance has gotta pay for care. There’s no track for care that is not covered by insurance, and Medicaid is a very hard population to work with. It is very important, and I wish we had cracked that code.

But we didn’t. It’s hard because so many of those overweight and obese children are poor and need this help, and I’m hopeful that someone can crack that code, but we didn’t.

Chris Madden:
Branding is not static, especially in health. Joanna and her team started with menopause care, but quickly realized women’s health can’t be neatly segmented the way the healthcare system often tries to do. And that learning shaped Midi’s evolution in a big way.

Joanna Strober:
When we started, we did think of ourselves as a menopause / perimenopause company. But what is perimenopause? It actually turns out that it’s most aspects of women’s health and you can’t take it apart.

So we found that women would come to us, we would give them a blood test, and we would find out that they had pre diabetes, and then where do you send them? You need to take care of them. You can’t just say, oh, we don’t take care of that, go elsewhere. I think that it’s a fallacy to think that health is segmented really narrowly. Women are complicated. We’re all complicated. Forget about women, right? You have a lot of different things going on in your body, and we found that we needed to take care of those things. We couldn’t just send them elsewhere.

And so if you think of it that we have this idea that, okay, I have a head problem, I’m gonna have a neurology issue, but honestly, maybe it’s neurology, maybe it’s a migraine, maybe it’s a hormone issue. Like what is it? And instead what we’ve had is we’ve had primary care and then we’ve had specialists.

But there’s this huge thing in the middle. And so our job is to be that thing in the middle, the women’s health experts, and to look at you and say, okay, I’m sorry you’re having migraines. Is this because of hormones? Let’s try that first, and then if it’s not, then we’ll send you an expert. And what we’ve been doing is making relationships with experts all over the country so that if we can’t take care of you, we can send you to the right place.

But I would say that for us, it really is around taking care of women’s bodies and understand women’s bodies. And perimenopause and menopause is a big part of that. It’s not as fragmented as you might think from an ad.

Chris Madden:
Jessica Holton is the co-founder of Ours Privacy. We introduced Jessica in episode 16 around navigating state level fragmentation. Ours Privacy was born from pivoting while solving a problem. HIPAA compliance is mandatory, whether the context is digital or not. Going back, it all began with the expansion of the first company Jessica started, which was called Ours.

Jessica Holton:
We started Ours several years ago as a couples relationship building program. So we started out as couples coaching, and we helped couples through the big conversations that they needed to have before getting married. So we became the largest premarital counseling provider in the country outside of the Catholic Church.

And we were building content and hosting live sessions for couples to work on their relationship at the time. And I still to this day feel that relationships are so incredibly important, if not the most important part of our human lives and human experience. And so me personally, I felt so drawn to that mission and the impacts that we could have for couples, and that was extremely motivating day to day, knowing that everything we were building was going towards the most important part of couples’ lives.

How we got into Ours Privacy was a couple of years ago, we shifted from coaching into couples therapy and we built out a HIPAA compliant therapy platform that matched couples with therapists. Now going beyond premarital counseling into all types of challenges, opportunities that couples had to work on with a therapist.

Part of becoming HIPAA compliant meant that we needed to review our marketing stack and how we were growing. And at the time, our acquisition channels that were most fruitful were Google Ads and Facebook Ads. And because we were not in the medical space beforehand, we had those pixels on our site.

Becoming a therapy platform meant we needed to take those down and we made the decision to take those down to absolutely comply with HIPAA and regulations and laws, but also because we cared and still care, of course, a lot about honoring our users’ privacy. We felt like being in the relationship space meant that we were serving people in their most vulnerable times in life sometimes, and such an intimate time of their life, that it started to feel like if we were to send that data back to Google and Facebook, it just didn’t feel right.

And so we wanted to make sure that we were having full control over what actually got sent out to Google and Facebook. We built a tool for ourselves to track the conversions that we needed to track on our site and anonymize them before sending them back to Google and Facebook. We also removed any potential health information, so made it a very generic event that we sent over to Google and Facebook.

And so with this in place, we felt comfortable continuing to use Google Ads and Facebook, and we were able to optimize, but knowing that we’re not sending anything identifiable and no health information over to these platforms.

And so we started building that out and building more deeply, adding multi touch attribution, cross domain tracking and making it really powerful for our use case. So much so that we started having partners reach out to us and founders reach out to us asking, hey, how do I set this up in my org, and can you help me set this up?

We had this moment realizing that we could have a huge impact on other healthcare organizations that need to solve this same exact problem. And so we shifted completely into focusing on Ours Privacy.

And in terms of motivation, I thought about this so much because several years ago I was waking up every day feeling very motivated by having an impact on the most important part of people’s lives. And today I feel extraordinarily motivated because we are having a large scale impact on an incredibly important, if not the most important part of people’s lives, which is their healthcare.

And we get to work with healthcare companies that span an entire spectrum of pre launch startups who are in digital health and haven’t started yet and are working on building out their marketing campaigns and reaching customers who need them and need their novel solutions, all the way through some of the nation’s largest health systems and big medical brand names.

And in those cases, we are helping healthcare companies across so many different verticals reach more patients and be known to more patients who need them, and helping those patients get solutions for their healthcare that actually works for them. And it’s a much bigger impact that we can have when we’re helping all of these different companies reach their hundreds of thousands, their millions of patients, compared to when we were navigating a direct to consumer business.

The scale is just so different. The mission orientation is certainly different, but as I’ve evolved in my thinking around and my understanding of how scary it is, how much these pixels can track about us and know about us, we’ve all Googled something and then had that follow us for weeks and months and we’ve all said something out loud, and then all of a sudden we get an ad for it.

It’s a scary thing when we’re dealing with our healthcare and such a personal part of our lives. And so being able to help healthcare companies not only grow, but do so while honoring their patients’ dignity is extremely motivating because we’re part of an overall solution that helps healthcare become more responsible and more honoring of consumers’ privacy.

Chris Madden:
There’s a thread that runs through all these founder stories, this sense of mission that keeps people grounded when the decisions get tough, and Ankit captures that perfectly with how he talks about Bicycle Health’s purpose. For him, having a clear North Star wasn’t optional. It’s what keeps the team focused when everything around you is shifting.

Ankit Gupta:
It’s so important to have a North star when you’re doing these things, that it’s both a new customer or some new impact that you had on the data, et cetera. For us, it was very clear from the beginning and even articulated our mission early on: increasing access to high quality, convenient, and confidential opioid use disorder treatment for all.

And the words are very intentional for us. We are an opioid use disorder treatment provider. That’s how we started. That’s what we stuck with. I can see us doing that for a long time. This is a huge problem and it only got worse during COVID. And so that focus on opioid use disorder allowed us to really build a best in class care model, build the partnerships, health plan, and now more so we’re building partnerships with referral providers.

We were intentional about being an opioid use disorder treatment provider. We were also intentional about we do want to be an opioid use treatment provider for all, or at least increase access to opioid use disorder treatment for all. That doesn’t mean we have to be providing all of the treatment, but we want to make sure if there’s a patient in any stage, in any health plan, with any acuity or opioid use disorder and co current condition, we’re able to help them get the right treatment, and some of that might be Bicycle Health providing that treatment, some of that might be partnerships.

But we want to make sure if for whatever reason something happens in my family, there’s a treatment pathway I can confidently help them get to so that they’ll get the help they need.

Chris Madden:
What I love about episodes like this is how honest the founders are about the messy middle, the early mistakes, the pivots and the choices that shaped what their companies became. These aren’t polished origin stories. They’re real lessons from people building solutions in a space where the stakes are unbelievably high.

If there’s one takeaway here, it’s this: the future of digital health will be shaped by people who are willing to explore, to question and to stay grounded in the mission of helping others. That combination, the curiosity with purpose and a bias towards taking action, is what creates real change.

But no founder builds alone. Our next episode, episode 23, is about building and leading marketing teams, how to scale culture, structure, and performance.

Chris Madden:
Healthcare is transforming fast from decentralized care to digital first interactions. The goal remains the same, which is improving the patient experience. This is Marketing Digital Health, and I'm your host, Chris Madden. This episode explores how health systems are adapting to new behaviors and expectations, creating more connected and personalized patient journeys.

Our first guest is Crystal Broj. Crystal has been working on a pilot program with Notable, an AI platform for healthcare operations that automates repetitive administrative workflows. They started small just with simple appointment reminders, and then expanded with the ability to confirm or cancel appointments, which led to patients getting to do the entire pre registration process if they select it before they even stepped into the office. Since then, the program has been able to take on more and more work, taking on the menial tasks so healthcare workers’ energy could be used elsewhere.

Crystal Broj:
As you talk about AI or AI agents taking work out of the system, think about how when you go to the doctor's office, they give you a clipboard.

Well, in this case, when we have this preregistration, everything you would do on the clipboard, including giving your driver's license, insurance, stuff like that, happens with a text message, and then it automatically goes into the EHR. So we started there and then we started adding onto it, adding more offices across, and now it's across all of our offices in South Carolina.

But then we also added not only confirm cancel, but the ability to copay before you get there and to pay prior balances. Wildly successful, our registration rate was doubled by that product. So when it was just Epic, it was about 24 percent of the people did their preregistration. We're well over 50 percent doing it now in electronic digital format.

We also dropped no shows by about 11 percent. And since we had Epic FastPass that was able to open those slots up and let people get in faster, access being the name of the game for most hospital systems today, and trying to find ways to either make more appointments or make them more efficient. And we also had a big uptick in copays.

So that's where we started the journey. So then we wanted to look for how do we update our website. We knew we were having a big website redesign, but it was gonna take 18 months before our total overhaul. So we wanted to just make better calls to action much more clear. And so if you go on MUSCHealth.org right now, you'll see there are four main buttons.

Find a doctor, find a location, get care now, and then very clear for the patient to be able to find it. We just launched this spring. DexCare is our front end for our find a provider, which is a wonderful tool. It lets people search using natural language processing. You can say you have elbow pain and it'll show you doctors that just orthopedics, that just do elbows, and not only does it do that, but has a map on the side.

And it shows you the times the doctors are available, which is total transparency. You don't have to log into MyChart, you don't have to do anything else. It's right there on our website. So if you need to find an appointment for one of your kids tomorrow, you can sort by first available, because sometimes you have your doctor, but it doesn't matter. Sometimes you are sick and you wanna see somebody right away.

Chris Madden:
Crystal describes even more programs they've enlisted into their telehealth, all to better patient experiences. The use of AI chatbots is making it easier for patients to manage their care while giving healthcare teams valuable time back.

Crystal Broj:
We also tie that into our telehealth, so along that list you'll see Get Care Now. If you click on that, you can actually get a telehealth appointment right away, either via text or on screen, or you can do a video visit. Those were some of the things for front door, and then we started working with our patient access center and we launched with a product called Amelia, which is a voice bot chatbot.

And we started again with very small, four lines. And she answers the phone, but she's not “press one for more options, press two for things,” but instead it's, “Hi, I am Emily, your digital assistant. How can I help you today?”

And with plain English, you can talk to Emily and say, “Oh, I wanna confirm my appointment for Tuesday and cancel the one for Thursday.” And she understands all of that. She'll verify you with our EHR and go, “Oh, okay. You're Crystal. So you have an appointment Tuesday at one o'clock, did you wanna talk about that one, and Thursday with Dr. Brown at five?”

So I'm like, “No, I need to cancel Dr. Brown and I wanna find the address I need to go to for Dr. Smith on Tuesday.” She can handle that entire conversation. So after we did that on four lines, being an NLP model, we had to tweak that a little bit, get it right, make sure there were words that she could not say like “mammogram” first. It was a very strange reason.

So we had to train the model, which is what you have to do in all AI cases, and she didn't understand last names. And being in the South, we have a lot of interesting last names. I have an interesting last name. It's Broj, but it's spelled BROJ. When I tested the bot and I said, “Who are you?” “I'm Broj.” And she goes, “Oh, Broy, B R O Y.”

And I said, “No, no, no, no, BROJ.” And she goes, “Oh, your last name is…” “No, no, no, no, BROJ.” And it was so frustrating. And so then you think, okay, well how do we train this bot so we could use the NATO alphabet, alpha, bravo, blah, blah, blah, you know, those. But not everybody does that. We're in the South, people could be saying B for bourbon, something like that.

And so there was no way to train even when we added the top 10,000 names in South Carolina. So we found a different way to authenticate so that our users wouldn't get frustrated. That is now on all 40 lines in our patient access center.

Amazing results, our wait times have gone down in half because Emily can answer all the calls and then route them to the appropriate agents to do the higher level volume. And our patient satisfaction scores have gone up, I think 11 notches for being able to contact the office. So patients love it.

It's in Spanish on a couple of lines as well, on our lines where we have Spanish speakers calling into those offices. So we are now expanding that into our revenue cycle, and we just launched that last week. And so it's answering billing questions, how to pay my balance. And we've seen really good results with that.

We get about 1,200 calls in our revenue cycle call center a day, and Amelia, on the first week, answered 25 percent of them without ever having to go to a human. So we're seeing some really good results with transformative digital tools.

Chris Madden:
The impact goes deeper than convenience. When you remove friction points, you open doors for patients who might have struggled to get care before, such as those with mobility challenges, language barriers, or limited time. As Crystal shares, automation is about helping health systems reach more people more equitably, and that's what real innovation looks like.

Crystal Broj:
It's really hard to navigate a health system and so however you can do it, we always keep in mind we do personas. So we have a bunch of personas. We have the busy mom with two small kids. We have an individual that's just single that lives downtown. We have people in rural areas that have problem speaking or have problems using digital. And we have one persona, Fred, who doesn't use digital at all.

And it's really important for us to consider all of those things when we're building out digital tools because Iris in Orangeburg probably will need her daughter to help her unless we can get a Spanish speaking line for her, and Fred's not gonna use anything. So we have to think about when he comes in the office, if he hasn't preregistered, how that'll work.

But really the whole point of a lot of the work that we were doing is access. If we can do prior authorizations, which is another tool that we've launched this year in our revenue cycle area. So we use an AI agent to go actually out to the payer site and type in all the information from the records, say for an MRI, for example, and it does it automatically and then it brings back the result.

That can take 15 to 30 minutes when a person does it and the agent does it in 30 seconds, saving a ton of time, and about 40 percent of them are instantly approved. So that takes a lot of work out of the system too. So that's great for our care team members because they can work on higher level tasks. It's great for patients because they're getting in to see the doctor sooner.

They're approved so they can schedule, so they can get in, so they can get the care they need. So at the end of the day, it's really an access play for all of these different tools. Getting that to show you the appointments, letting you schedule, letting you pick the time and place that you want, and making it easy for patients.

Chris Madden:
The whole experience of telehealth is creating an incredible connection for patients. It's giving them important reminders. It's allowing them to pay a bill online, to schedule and see their doctor online. Healthcare workers are having their own burdens reduced so they can give more time to patients.

We're automating the mundane phone calls and appointment reminders so we can focus on the patient in the room. Clay Holderman is the CEO of Avia. We introduced Clay in episode 13 around partnerships for growth. Clay talks about what he's seen firsthand.

Clay Holderman:
In spite of huge financial headwinds, the interest in the consumer orchestration journey has not diminished. And so we still have many of our members, probably fully half of our members, that are prioritizing getting away from a transactional web based or phone based “I can make a schedule, I can book an appointment, I can pay a bill, I can fill out forms” to an actual engagement where it's been personalized and it is proactive and it's predictive about my needs, and it's engaging me in a continual way.

So that orchestrated experience is a big theme. Another one is connected care everywhere. Through COVID, everyone accelerated what they were doing in at home programs, at home monitoring, virtual nursing, virtual urgent care, virtual physician visits, behavioral visits, all kinds of virtual cares.

How do you take these connected care programs and put them into a single care model? Because often they were fragmented. They were often bought or created through different solutions. They weren't integrated into the electronic health record and they weren't generating a note that became part of the EMR. They often were not reimbursable or reimbursable only under a value based care contract, only under an emergency use authorization.

Helping people to now create a care model and a business model around their connected care devices, including wearables in some cases, depending on the market. Those are two big trends. The third is all things telephonic and outreach. And the easiest is SMS text, which is old technology, easy to implement, cheap to program, but we find that it has a response rate that's much, much more effective than a phone call.

And so using SMS text for everything from appointment reminders, to post follow up care reminder, to billing processes, to helping people with chronic conditions to remember to take their daily weight check in and record their glucose. Now being able to automate those tasks, you can talk to a lonely senior as long as she wants to talk, and you can answer questions about the discharge instructions, about the home medications, and the AI agent can take action to ping the pharmacy and see if the medication's ready, have it delivered to the home, change the delivery address, set the follow up appointment, all without a human touching that process unless the agent escalates it out.

Chris Madden:
Automation is driving massive ROI across healthcare, but it's not just about saving dollars, it's about saving energy. When staff no longer spends hours chasing forms or rescheduling appointments, they can reinvest that time into patients.

Krystal's team has found real measurable wins here. The kind that prove automation isn't replacing people. Instead it's empowering them.

Crystal Broj:
There's a certain cost to putting in that voice technology and we first went through it, it was like, “Oh, this is a great idea, it's gonna save time.” And the first thing you know, any finance department's gonna go, “Okay, you're saving time. How much time are we gonna be able to reduce headcounts?” And the answer is no.

But we couldn't hire enough people for the patient access center. We really had 30 open reqs and we had long wait times, which we talked about before. We had people getting frustrated, hanging up because they were waiting. But we couldn't meet the standards that we had anticipated or wanted to set for ourselves for that.

We watched how many calls are deflected. We watched how many calls are confirmed, canceled, and taking the industry average of six minutes per call, and then say, well, we know that we're saving at least three to five minutes. We deflected 275,000 calls that did not have to go to a person in fiscal year 25.

And if you take that three to five minutes, that comes out to about 32,000 hours of savings when you then don't have to hire someone else to keep up with that load. And we've been in a system that's growing, so we can just keep getting people into our system that wanna call. And you don't have to do that, and you can cut your wait times down so your staff's being more efficient.

They don't feel as burned out because they actually can breathe in between a phone call before they gotta grab another one again. So that's the soft ROI. You can't count people feeling better, but you can count the amount of work that they can do and the metrics that you have around it, reduced wait times and things like that.

Is there a financial savings? In a way, because we didn't have to hire the extra people, but also because we can then expand because we have technology and we can expand to cover other patient access centers too, which is great then because we can train our agents to answer any call across the network with AI helping at the front end to direct it to the right person.

Chris Madden:
Dr. Aabed Meer sees this evolution from the physician side. Dr. Aabed Meer is a physician and investor. We first introduced Dr. Aabed Meer in episode one when he contributed to our discussion around why marketing digital health matters. He knows firsthand how new tools can make care more efficient without sacrificing empathy.

His approach to innovation is simple. If it helps patients and makes doctors' lives easier, it's worth doing. It's that balance between clinical precision and compassionate care that defines where healthcare is heading.

Dr. Aabed Meer:
If you look at the last 20, 30, 40 years, the ratio of time spent with the patient to the ratio of time spent on administrative tasks has only decreased, i.e., we spend less time with patients today than we used to, and we spend more time on administrative tasks today than we used to.

And that's not the direction in which physicians want to go. That's not the direction in which patients want to go either. And the types of innovations, including scribes or ambient scribes, are exactly the type of innovation that we need in healthcare because it helps that physician, that provider, to shift their attention from these administrative tasks to what really matters, which is patient care.

Chris Madden:
Dr. Aabed Meer also highlights something many overlook, which is that telehealth isn't meant to replace in person care. It's about giving patients the right care at the right time through the right channel. Sometimes that's a virtual visit, sometimes that's face to face.

The key is flexibility. And that flexibility is what today's patients have come to expect.

Dr. Aabed Meer:
There's certainly a difference between where virtual care is relevant and is the best way of delivering care versus where in person care is most relevant and the best way of delivering care. And the analogy I would use here is when folks buy clothes.

There are folks that love the convenience of online shopping and buy clothes there, and there's some folks who may still want to go in person to a store and buy clothes in person. And in healthcare, similarly, a virtual care visit or a telehealth visit certainly has the convenience and the urgency that an in person visit may not have.

But depending on what an individual is dealing with from a medical perspective, it's really about what is most relevant to the individual with a given condition in that moment. And so broadly speaking, telehealth and virtual care have expanded access to care, which is fantastic, particularly in parts of this country that don't otherwise have access to care.

Rural America, unfortunately, doesn't have as much access to care, and we're seeing organizations that are able to deliver virtual care actually reach these parts of the country, which is great. Now, at the same time, virtual care may not be perfect for certain types of care, right. So it depends. It certainly depends on the acuity of what the patient or the individual is experiencing.

Chris Madden:
The government and private stakeholders didn't always see the benefits of telehealth. While the technology has been around, what's new is the recognition, reimbursement, and adoption behind it. The pandemic didn't invent virtual care. It simply forced the system to embrace it.

Dr. Aabed Meer:
The technology to enable telehealth or virtual care has been around for a long time, and there was this first generation of companies that came into being sometime between a decade and a decade and a half when these technologies were available.

However, it took a pandemic to help us recognize that these were viable forms of delivering care, and it also took a pandemic for stakeholders, whether government or private payers, to recognize that telehealth was worth reimbursing for. We can't get away from the fact that healthcare is a regulated industry for good reason, and therefore adoption of technologies like virtual care or telehealth is dependent on whether there are billing codes, for example, that allow a physician to bill for a telehealth visit.

And so in the last few years, we've seen that transition happen, and that's been a catalyst for the increase in telehealth that we're seeing today versus the prevalence of telehealth even just five years ago.

Chris Madden:
Crystal adds another layer here. The idea that digital adoption isn't just for the tech savvy or the young. We're seeing seniors, parents, caregivers, and patients across every age bracket embracing digital tools when they're built intuitively.

That's the future of engagement. Meet people where they are, but design for everyone.

Crystal Broj:
There's an assumption that age makes a difference in tech adoption. And from what we've seen, it's not the case. Our 65 plus generation, although you would think that they wanna call all the time, they're adopting technology and doing online scheduling, for example, or things like that, at a rate that's very similar to a millennial, for example.

And so that stereotypical thing that they won't use it is something that actually is not true. And I think while you think tools are easy enough to use, and it should be really simple, you still have to be willing to train your staff and spend some time so they feel confident, especially when you're introducing a new process.

So if I'm doing it this way, I've done it this way for three, five years, and then I give them a new tool and they're trained well and they aren't comfortable, they're certainly not gonna wanna use that tool in front of the patient because they were efficient before, so they don't wanna look dumb doing their job. And then you'll have non adoption as well.

So you really have to work with whoever your customer is at that point to make sure that they feel comfortable enough to use it.

Chris Madden:
Joe Cannon is the SVP of Global Partnerships at Hyperice. We introduced Joe in episode four around storytelling and trust. He's been watching how wellness and longevity tech are redefining what healthcare even means.

Patients aren't just waiting for care, they're tracking, testing, and optimizing their health every day. It's a total mindset shift from reactive medicine to proactive wellness.

Joe Cannon:
That's the future of where we're going and what we're doing is trying to increase those conversations. We're seeing tons of growth in the diagnostic space with like Lifeforce and Function and Superpower. People want to understand what's happening inside their body more than they are having that conversation with their general practitioner.

The rise in functional medicine is at an all time high, and I think will continue to grow. I think it's that conversation where it's like they're starting to take what we're putting into our bodies into account. We're starting to take what our biometrics are doing.

The next level of longevity is obviously having a just an unbelievable moment with Huberman and Attia and Sinclair and those guys. They're doing incredible work and really bringing the forefront of a lot of the studies that we've been building on for years to the masses and where we're going.

So it is this wonderful wrap of all these wonderful spaces coming together. It's health, it's wellness, it's fitness, it's spa, it's body care, it's MSK. It's all of these things telling a story on how we're gonna feel and move better.

Chris Madden:
Since the pandemic, patients have become more empowered and more self aware. Joe points out that people now expect healthcare to fit into their lifestyles, not the other way around. They want insights, personalization, and the ability to act on their data in real time.

It's a powerful shift from patients receiving care to people managing their health.

Joe Cannon:
Consumer expectations post COVID and during COVID have changed dramatically around people's worry that, oh, like, damn, we might not live forever and we might not live that well. And I think a lot of millennials have seen their parents, a lot of boomers have seen their parents' bodies deteriorate. And when you stop moving, you start dying very, very quickly.

And you see those people in the gym that are 80 and they're in great shape and they're crushing it and they are the exception to the rule. It's how do we build these bodies for that not to be the exception by the time we get there. And I think the expectation now is you wanna live a long time, but you wanna live a great life.

You don't wanna just be hurt or broken or whatever. And I think so many, even millennials, might not be saveable in the sense of a lot of the MSK issues. I have numerous friends who are 40 and below that have had hip replacements or knee replacements at this age. And when you think about that, that's crazy.

Where that's coming from, repetitive strain, sitting, biking, whatever it's been that has caused these issues. How do we prevent that? And I think people don't want to see this happening and see this happen to their parents, or back issues or whatnot, and they want to fix it now.

That's really exciting about the space, that people don't want to be hurt, and people are looking for alternative medicine resources now to help them achieve those health outcomes, which is pretty cool. A lot of people are going to doctors, they're going to chiropractors, they're going to physical therapists on their own.

Chris Madden:
Chris Turitzin is a growth advisor for digital health companies and is the founder of Single Aim Marketing. We introduced Chris in episode one around why marketing digital health matters.

Chris jumps in to look at this from the marketing side. He's seen how COVID accelerated the digital curve, pushing health systems to modernize fast. What used to take years of planning now happens in months. That urgency created new habits that stuck and opened the door for healthcare to finally compete on experience.

Chris Turitzin:
Basically because of the pandemic, some regulations opened up and generally companies that gatekeep in healthcare became more telemedicine friendly. I'm talking about insurers, for example. They started accepting telemedicine companies, and what that meant was there's this huge cohort of companies that showed up in that time and essentially I would say saturated all of the verticals.

So if you look at all the mental health verticals, dietician verticals, men's, women's health, weight loss, GLP-1s, addiction, various metabolic health, there's a lot of players in all of those.

I think the next frontier is in areas that have some form of in person treatment or some form of regulation requiring in person service. So that could be like the prescription of controlled medications, it could be running procedures. And I think we're already seeing that the telemedicine markets are relatively saturated, in person markets are very much not saturated.

Just the experience of a consumer trying to get an ophthalmology appointment and you have to wait six months. It's obviously not saturated from a supply perspective. So what we're seeing is a lot of movement starting in these consumer in person markets. So med spa being the prime example here.

There's just been a lot of growth there over the last few years, but others like direct primary care, optometry, dental, longevity, fertility, a lot of expansion of in person clinics.

And what's next after that is moving to less consumer markets, but still very high demand and supply constrained. These are just examples that I've talked to physicians about, like ophthalmology, urology, primary care, wound care.

The model that we'll likely see is like a physician pod model where a physician is kind of at the center and they're managing a team of NPs and PAs who basically are these business managers running clinics wherever in the country. So that's generally what I think we're gonna see next.

One reason I go into healthcare and one reason I maintain healthcare is I think competition is good and we need more competition. And you kind of have to come in from these peripheral markets, these consumer healthcare markets, and slowly eat into these more core healthcare markets. And as you do that, you start to compete with the more traditional healthcare options. You're basically just offering more good options.

So I think it's generally all a good thing. It's happening slowly. That's what I see in terms of maybe the next five to ten years. There's just gonna be, so much healthcare is gonna be provided by advanced practice practitioners. That's just the future. It's just purely a numbers game.

So the question is, will the world be set up, in which way will they be employed by large organizations like health systems or will they be more in some sort of autonomous model, either fully independent or in that kind of pod structure with the physician as I was talking about.

Chris Madden:
Clay wraps it up by zooming back out to the system level. Workforce shortages, rising demand, higher expectations. Healthcare's next chapter depends on automation and smart technology to close those gaps.

As he puts it, this isn't about replacing people, it's about redesigning the system so care teams can focus on what matters most: connection.

Clay Holderman:
So there's not a silver bullet. There's not just one solution. We have the most complex health system of the world. It's made up of at least five or six sub health systems based on reimbursement category. We have one health system for our veterans. We have one health system for our Medicare population and retirees.

We have another population for the poor and for women undergoing pregnancy and children in the Medicaid system. We have the indigent and undocumented that largely come into indigent care and EMTALA required care inside of health systems. We have the commercially insured, which breaks down into multiple different health systems.

All of those are billed differently. All of those have different prior authorization requirements. They all have different formularies. They all have different workflows associated. That complexity doesn't have just one solution.

However, the combination of the 2030 problem, diminishing workforce, increasing patient demand, increasing patient complexity, and diminishing revenue from the shift to government payers, I think the adoption of automated technologies to replace what workforce used to be able to do is now critical, more critical than ever.

And it doesn't matter if this is going back to 20 years ago and it's just simple robotic process automation and task automation, or whether it's going to some actual intelligent automation, or we're getting into real autonomous decision making and AI enabled workflows, or we're working upstream into really context aware AI agents, or really a composable system of multi agent autonomous operations and composable intelligence, that entire continuum is available to us.

But what really got interesting, we had OpenAI come out in 2023 and change the market on intelligence approaching AI, but it was still populating workflows for humans. Now, agentic and autonomous workflows are doing something different. Instead of populating a workflow for a human to complete, it can complete an administrative task.

It can complete a clinical task if we decide it's ethical and safe. And so with those in front of us, a huge part of the solutions of the 2030 problem has got to be scale adoption of autonomous workflows and innovation.

Chris Madden:
If there's one takeaway from today, it's that patient expectations are rewriting the rules of engagement. Healthcare isn't just about appointments and outcomes anymore. It's about experience, empowerment, and access.

From automated workflows to virtual visits and personalized communication, the organizations that thrive will be the ones that stay curious, stay flexible, and stay human, because the future of healthcare isn't digital instead of personal. It's digital so it can be personal.

Behind every movement are the founders who built it. Episode 22 brings raw stories from digital health entrepreneurs and the lessons they learned the hard way.

Chris Madden:
Hospitals are facing a new kind of competition. Patients want convenience, they want digital first access, and they're willing to switch providers to get it. This is Marketing Digital Health, and I'm your host, Chris Madden. The hospital systems that win today are not just delivering great care, they are building modern marketing engines around it.

Everything from telemedicine to patient portals to branded digital experiences becomes part of how you show up in the market, and that is what we are digging into in this episode. How traditional health systems are rethinking their strategies, embracing new tools, and meeting patients where they are, not where the industry used to expect them to be, which was in their office.

Kali Arduini Iday is the Director of Ventures and Innovation at Northwestern Medicine. We introduced Kali in episode one around why marketing digital health matters. Northwestern showcases how digital tools can expand access. Patient portals, telemedicine, virtual first, giving patients easy, instant access is a great way for hospitals to market their service.

Kali Arduini Ihde:
The neat thing about digital is it is everybody's responsibilities. So our primary care leadership has really taken the charge of thinking through, there are so many different types and different needs of our patients in terms of their kind of core primary care. We have patients who are pretty healthy, they do not need much.

Occasionally they are gonna want to get lab work done and checked in on just their overall wellness. Occasionally they may come down with a bug or a virus, and so they are gonna need some kind of quick immediate care. But then you are also gonna have individuals who have multiple chronic problems, are on many medications, need a lot of assistance because they are just battling a lot of healthcare needs.

And so we are looking at both kind of simplified digital first offerings to help those patients that do not need a lot, they just need access occasionally when they need it, but also much more kind of what we call complex care clinics that can be focused on those patients who maybe have diabetes and high blood pressure and maybe cardiac issues as well, so that we can really cater the experience to them and have physicians who specialize in those multiple conditions and how to treat them and how to build a care program and a pathway that works for them.

And so when we think of the digital first, both of those environments can benefit from digital tools. And so when we think of digital first on the easy, most of those patients just need a quick telehealth visit. They have a condition that is pretty easy to check in on without extensive examination, although maybe occasionally they will need to come in.

So we have very much adopted telehealth. In some areas we are looking at remote patient monitoring where we can provide patients with devices. We also look at how can we interact with our patients without even making them schedule a telehealth or other visit. Are there ways we can do it just via the portal, so patients with conditions that I can just ask questions, have them fill out a questionnaire as a physician, have them respond back, and then I can tell them what the next step was going to be.

Fortunately, our insurance companies now offer payment for that, and that is covered through the services they offer patients. And so then these sort of asynchronous methods of getting care can be done as well. So then again, we are not making people drive to downtown Chicago. We are not making people get away from work and get their day disrupted.

And then on the complex side, we have really thought through how do we have a pre visit, during visit, and post visit complete digital experience. And so pre visit, it is making sure that if there are questions we want to ask you or you have questions, how can we get those in advance via a portal, via questionnaire, via a digital interaction during the visit.

Tools like this ambient tool are critical, because these patients, these conversations can go in many different directions. There is a lot going on. There is going to be a lot of follow up. How do we make that time in the room more enabled as well. And then post visit, are there tools, and we are looking at some of these, where it actually engages the patient after the visit without the physician and or a nurse or others having to stop their in person work and reach out.

There are patient engagement tools that allow for check ins periodically, they can upload information, it puts reminders out there and education periodically before their next visit, based on the decisions that were made during an in person appointment.

Chris Madden:
Crystal Broy is the Chief Digital Transformation Officer at MUSC Health. We introduced Crystal in episode 18 around AI’s impact on health marketing. A smart health system pulls its marketing team into every stage of the patient journey. It is not an afterthought, it is part of the build. Crystal shares how MUSC partners deeply with marketing to make sure each digital tool feels unified, on brand, and seamless to patients.

Because the truth is patients do not care how many vendors you are using, they just care whether the experience feels like one cohesive system.

Crystal Broj:
I am really good friends with our marketing team and we run a lot of things by them, and they are very gracious to give us their time. And we partner on some projects like our website with Dex Care.

Our marketing team was there one hundred percent of the way, making sure look, feel, brand voice was in our, we call it one MUSC for across all three organizations, research, health, and academic. But also, when you think about it, if I go online, in Dex Care, I make an appointment and then I need to change it.

So I might call the patient access center. And then I might get my notification from Notable that says, hey, it is time for me to come in, and then maybe it is for a colonoscopy. So I get a follow up educational path from Andor, four different systems. Plus then I am gonna go in and look at my after visit summary in MyChart.

But we want that to feel like one system. We do not want to feel like you are bouncing in and out of all these experiences. So we work very hard with our vendors and the marketing team to make sure that it looks like us. It does not look like you are jumping out of the experience, and I think that is another thing that vendors have to, you know, that white labeling thing to make it look like my tool and not their tool is super important.

Chris Madden:
I talked with Clay Holderman about Avia’s collaborative model. Clay Holderman is the CEO of Avia. We introduced Clay in episode 13 around partnerships for growth. Marketing plays a bigger role than people might realize. When health systems compare notes, learn together, and share what is working, they adapt faster.

And in a market where patient expectations shift by the month, that speed becomes a competitive advantage.

Clay Holderman:
Avia’s collaboration model is, it is core to our DNA and it is core to our differentiation. At its core, we are a membership organization and our members love to come together and compare notes on what is emerging as trends.

What are the most important problems, what are the most promising solutions, and just sharing experience and information. So we create multiple channels for innovation leaders, digital leaders, IT leaders, for operational leaders, recently for governmental relations leaders in the governmental transition and deregulation.

For marketing leaders, we have an entire generative AI community of adoption for marketing leaders and how to improve patient communications and how to automate and personalize patient communications in a way that it will actually activate patients, meeting people where they are. For a one time membership, but allowing them to enjoy multiple channels in multiple forums is the first part of Avia’s collaboration.

That is magic. I think the second part is when we do identify something that is of great interest to multiple members, usually eight to twelve at a time. The extreme example of this was when generative ai, when open ai released chat GPT in 2023. We instantly pulled together twenty nine health systems at once, and we were able to hire and bring in leading technology experts, leading governmental policy experts, international experts in AI ethics and regulation.

And we were able to instantly upskill C suite leaders in how to think about what was coming on the horizon. We helped them put together eleven frameworks for evaluation of ai, put together market leading AI governance models, and how you get your organization ready. That community was so successful that about twenty of those health systems wanted to go on to 2.0, which focused on use case identification.

And again, we were able to bring in solution companies and share what they are doing in the space. And we had executives from health systems ranking use cases, we were able to then publish to them the sequence of use cases that were in the sequence of implementation, but also in return on investment and readiness for prime time.

And that was 2.0. And then 3.0 we moved to communities of adoption. When we do that, you know, that cost of global and national expertise is split among many, many health systems and sometimes offset by a solution company sponsor. And yet our customer success managers come alongside, who know each health system well as their member, and make sure that each health system gets a unique implementation plan and action plan and follow up plan that is tailored to their unique environment.

Whether they are Stanford in a rural environment or they are Northwestern in Chicago, they all have a different set of implementation issues to think about, and we help them sequence that coming away. So, fractional expense for global and national expertise, and we think a multiplied impact from hearing from real world experiences of peers during the collaborative.

Chris Madden:
You have heard me say this on past episodes, traditional referral based marketing is massive in healthcare, and now we are watching AI reshape it.

Crystal explains how modernizing something as old fashioned as a faxed referral can dramatically improve patient conversion. This is what marketing can look like in healthcare today, fixing the operational bottlenecks that actually cost you patients.

Crystal Broj:
The most interesting thing about referrals is that if Chris, you refer me to go see Dr. Smith, the person at the front desk schedules that right away for you. Then it goes into an order. That order gets faxed to our patient access center. Yes, in this day and age we still do faxes, and that sits in a queue, and then somebody pulls that and has to type it into Epic, and then it goes into another queue where somebody calls and says, hey Crystal, we are ready to have you schedule, a lot of labor intensive stuff.

And as you can imagine, it takes a long time to get through. So my referral could sit for several days before it actually gets processed. Again, if we can take that, and we do right now, we have started with two service lines that take that fax automatically, OCR it and pull all the important information off and then put it into a queue that then could be processed by a person, saving a lot of time there.

But once we get that process really well defined, and I think you will see a theme that we start small and increase, then we will be able to have AI agent that goes through that, and for those things that you can automatically schedule, then I will send you a note and say, here you go, you can now schedule your MRI, click here to schedule, pick the date and time that you want, and if you do not, then someone would call you. We are working on voice agents outbound so that we could call instead if you do not answer a text.

But then think about things that are a little bit more difficult, and as we work on prior authorizations, that is one piece of the pie. So if you had a referral that needed a prior authorization before you could schedule, we would insert that prior authorization logic in there. Then you would know your prior authorization has been approved.

You can now schedule. We have also had some requests from doctors to let them know when their referral is scheduled, because right now they have no insight into that. That is a very easy AI agent thing, to say prior auth has been approved, here you go doctor, this is it that Crystal went to her appointment, here you go doctor, just so you know that she followed through. And so I think with AI agents, we are really gonna be able to close the loop on a lot of things and make it easier for the doctors, make it easier for patients, and really get them care faster.

Chris Madden:
Is AI saving time and money. Kali has been around this tech since the early pilot days, back when AI meant humans double checking outputs behind the scenes.

Her perspective gives a real look at how these tools evolve and what it takes to prove value inside a traditional healthcare system. And that proof is what unlocks executive buy in for future innovation.

Kali Arduini Ihde:
We were a fairly early adopter of the technology. We were working with some of the players before it truly was automatic and ai, and we were working with our partner back when they had a four hour delay because they wanted to have a quality specialist review it quickly before it got into the hands of the physicians. And so we have been on this journey for a number of years. So for us, it followed that same pilot process, because we wanted to be able to build that true value proposition and that true case for why this was not just good because it generated some positive survey feedback, but that we could actually quantify with our physicians, is it actually saving you time.

Many of our physicians wanted to see that too. They had heard from others that people liked it, but liking something and actually it providing the value that you hoped it would in saving you time are two different things.

So our pilot was really focused on quantifying all the positives that we had heard about this tool. So we spent four months doing that, absolutely generated that business case, plus all the positive end patient experience. Saw that our physicians were giving that time back to our patients in additional visits.

So we were even opening up access, which is so key these days when many of our specialties and all of our physicians are in high demand, and sometimes wait times to get an appointment can be pretty far out there.

Chris Madden:
As Kali digs into early findings from their latest pilot, you can feel the momentum. They are seeing better patient experiences, more physician time, and ultimately more accessible care.

That is the kind of outcome every health system is trying to market, faster access, clearer communication, and patients who feel supported at every step.

Kali Arduini Ihde:
We are quite early, so we met the company last year, did our vetting diligence, got them connected with our folks in our GI space, who also were part of course of the vetting. Our procedural surgeons are part of that.

Our administrators, those nurses who are making those calls today, were part of that process and really got through that in the fall and kicked off our planning for the pilot here at the start of the year. So we just activated this last week. We are excited about what we have seen so far. Naturally with any technology, we are dipping our toe versus diving in, especially again since this is AI making a phone call directly to our patients.

We are starting with supervised phone calls, so we are letting the AI take the lead, but we do have a nurse on those calls to be able to step in if for one reason or another something is not said correctly, we need to tweak the ai, things like that. And so we are gonna do a number of those phone calls before we move forward with the truly AI only kind making these calls.

We are also recognizing that unlike sometimes with technology where you turn it on and you work through the issues while it is still going, we are also finding that it is better to just pause, have our nurses continue making those calls, and then update the technology and then try again.

So really going step by step through this process so that the experience on the patient side is as optimal as we can make it as we work through this. But the potential is so incredible, the AI that is out there and what it is capable of doing, and in the moment able to shift based on what patients say and pulling information both from Northwestern Medicine’s protocols and pathways and the rules we use to work with our patients.

But also more broadly, if a patient has a question about, hey, I am going out to an Indian dinner two days before this, what should I eat so that I am not setting myself up for discomfort during this procedure. It can say, hey, you live in this area, here are the local restaurants, here are a couple items on the menu that are probably gonna be better for you than others.

And so it is incredible how it can pull so much information together to really have a meaningful conversation with that patient. And it can do as many at the same time as it can. So it can be making ten concurrent phone calls, it can be making twenty, it can stay on that call with the patient five minutes, fifteen, twenty, whatever that patient needs. That patient will never feel like the person on the other side of that call is trying to wrap up or trying to move on because they have a list of additional patients that need to be connected with.

Chris Madden:
There is always that moment when a pilot stops being a pilot and becomes the new normal. Kelly walks us through how Northwestern is scaling their AI tools across hundreds of physicians, and this is where the real marketing advantage shows up, consistency. When every clinic delivers the same strong digital forward experience, your brand is not just a logo, it is a lived patient reality.

Kali Arduini Ihde:
We are on that journey right now from transitioning from pilot to, it is just part of what we do. So we are currently activating anywhere from one hundred to one hundred fifty physicians every month on this tool across our medical groups. So that is fantastic. It means that we have a targeted focus, and that is still staying within innovation for now, because we did not wanna be the team that just piloted and then said, okay, figure out how to get it to everybody.

We also wanted to be the group that helped enable those outcomes everywhere, across all the potential folks who could get the benefit from them. And so right now, my team is still owning that. We do these monthly activations. The onboarding process we found is incredibly important to truly, physicians feeling the burden lessen, as well as being able to really get all of those different benefits from the tool.

And so we have a little bit of a choose your own journey approach, where physicians can do self learning through e learnings and videos. They can join webinars and town halls with peers to hear how others are using it and just get more hands on training. We even have onsite assistance, a combination of folks from our vendor as well as from Northwestern, even peers.

So we have a few physicians who are so bought into this tool that they are volunteering their time to go help their peers get onboarded because they know that if you can really get it embedded into the work that you do every day, it can truly make the physician career experience more enjoyable.

Chris Madden:
Ben Riggs is a writer and content manager at Kettering Health. We introduced Ben in episode four around storytelling and trust. Content has become one of the most important ways to grow and differentiate a healthcare brand. Ben talks about how AI fits into that process, and just as importantly, where he is cautious.

There is still a human touch that matters in storytelling, especially when you are trying to connect with patients and build trust on behalf of a healthcare system. And the systems that balance AI efficiency with human authenticity are the ones that will cut through the noise.

Ben Riggs:
So using AI and content, that is the big sticky wicket these days for sure. I think we are still learning how to use it. I am someone who went from the tinfoil hat member of 22, I think that is when Chad GPT first came on the scene, to I very much view it like a frenemy now because I understand it more, and I have understood it more by way of using it more.

And I think there are things that are categorically impressive about it, just the fact that it can do what it can do from an analysis perspective, from a search perspective, from sifting through things. I do not wanna sound bougie, but I am still not even close to impressed with what it can do from a written perspective in terms of this feels like the quality of content that we would publish, and there are a few low hanging fruit ways that we can use it.

A lot of this comes with making sure the people we are talking with know we are using it this way. But I think AI can be great for transcribing interviews as well as helping analyze and evaluate them. And I think this is particularly true for conversations with subject matter experts on information that you would probably already find published somewhere else.

I do not have in view like a patient story or a physician profile, anything that would maybe risk either a HIPAA violation or just the common decency of, if I interview a patient or a physician, if they have shared their story with me, I am not gonna go just start telling it to other people that I do not know. So I would not do the same thing with a large language model, I would not just share that story there.

Using it for analyzing interviews, sifting through that, transcribing of sorts. I think too, obviously doing some contextual research is always helpful, but note there still, and probably will always be, ironically, you need to do some fact checking on the research and make sure there is no hallucinations or anything fabricated or whatnot.

I really like to use it on the front end of the writing process. I think between kind of ideation through that research reporting phase, I have used it a little bit with helping me think through some structures or some outlines for things. And just to be frank, it is not like I am ever trying to write the next Great American novel as a content marketer within healthcare. Most of the time those outlines are not gonna be, there is not gonna be anything brand new I am gonna come up with.

And so what it feeds me can be helpful, even if it is just to get the ball started rolling down the hill. So on the front end, I think it is helpful, and it can be helpful on the back end as well. There have been times where I have written something and I have just known this can be cut half a word count. This forty word sentence can be definitely condensed and made more brief, but I have spent so much time with it, I do not know how to do it.

So I will feed that line to LLM and just give it the prompt of brevity and just ask for five versions and see what it comes up with. And somewhere in between one or three, I can see the sentence I am aiming for. So front end, back end, when it comes to drafting and revising, I am still leery. I still think too, there is a lot to be had about creating content that is written from a human, for a human, which AI and search actually rewards more than stuff written by ai.

And so I think that, but two, I think I am just not ready to delegate that away just yet, because one, I just have not seen anything that feels commensurate with what we want to produce and publish, but also I think I am starting to see stuff, and I think we all knew it was gonna start to happen, not just AI slop, but the AI rot sort of idea of giving up some of our critical faculties in a slow way as we are delegating whole projects to it.

That is where we are applying AI from a content production perspective.

Chris Madden:
What we heard today shows a clear truth. Modern healthcare marketing is no longer just about campaigns, it is about experience. Every digital tool, every AI workflow, every branded touchpoint, every seamless appointment becomes a message to the market about who you are and how you care.

Hospitals that embrace these strategies are not just keeping up, they are standing out. They are showing patients that access can be simple, communication can be thoughtful, and care can meet them exactly where they are. That is how traditional systems stay competitive. In a world where consumer expectations are rising fast, patients themselves are evolving just as fast.

Our next episode, episode 21, dives into emerging expectations, new behaviors, new demands, and how marketers must adapt.

Chris Madden:
In digital health, things are changing fast, especially when it comes to privacy. We're in a moment where patient trust isn't just a value. It can be a strategy. And the way we earn that trust is shifting from collect data first and sort it out later to something much more intentional, consent based infrastructure.

That means building systems where patients choose how their data is used, where marketers and platforms are smart enough to respect those choices without slowing down growth. This is Marketing Digital Health, and I'm your host, Chris Madden. We're not just talking about policy, we're talking major technical shifts from how pixels get deployed to how CRMs and CDPs manage PHI, to how ad platforms are rethinking who they'll even let you target.

This episode is all about that intersection, how to stay compliant while still reaching the right people, building trust and driving conversions. To help us break it down, we're talking with Adam Putterman and Jessica Holton, two leaders navigating this exact moment from both the tech and marketing sides.

Adam Putterman is the co-founder of Ours Privacy. We first introduced Adam in episode 10 when we discussed technical setup around events, signal resilience and attribution. Adam starts us off by talking about just how fast things shifted in the past year or two. Not gradually, but dramatically. Big names like the FTC and OCR have gone from background players to headline makers.

Privacy lawsuits are on the rise. Compliance can't be just an afterthought anymore. It's a board level issue. Let's listen to Adam to break it down.

Adam Putterman:
The industry as a whole has massively improved its approach and stance towards patient privacy and compliance in general. And a lot of that is because of effective, but very publicized action by the FTC, the OCR, and just a wildly increasing amount of class action lawsuits against healthcare companies, and we're still seeing that today.

It's changed a lot. I think if you went back two years ago, you would find most companies not just sharing some things, but sharing everything fully. Not just pixel, but capturing and sharing back everything because again, that's just how marketing works today. If you look at most large digital health companies, they're one using a CDP or some internally built tool to remove as many user properties as they can while still effectively advertising.

They're doing the same for analytics if their analytics provider doesn't sign a BAA, which many do now, which is great. And another improvement in terms of like the companies we see because we have a lot of companies that come to us for audits or just to take a look at their performance. It's 50–50 in terms of whether they're just sharing a click ID or sharing a click ID with an obfuscated event and an IP address or a click ID with an obfuscated event and a hashed email.

It's pretty evenly split. I rarely see a company that's coming now and just optimizing for standard purchase events. With everything shared, there's usually some action being taken.

Chris Madden:
The BetterHelp settlement, something we've touched on previously in the series, was a warning shot for all companies.

Protecting consumer data and staying compliant has to be taken seriously. If you're handling patient data at scale and you're not compliant, it's only a matter of time before someone notices. Adam expands on how that one case shifted internal conversations about risk for everyone watching.

Adam Putterman:
The big wake up call for a lot of companies was one, the BetterHelp settlement with FTC, just because BetterHelp has such an extreme scale.

That many companies use it as an internal comp for compliance practices and really compliance risk. And then two was the letter sent to, I think it was 130 different health systems, explicitly warning them about the megapixel and pixeling practices in general. Huge wake up call. And then three was just seeing that civil class action lawsuits were increasing in scale more and more.

I think that was the big fear driver for a lot of digital health companies in particular, because even if you think, oh, the FTC or the OCR isn't gonna come after me, there's nothing stopping a class action. Also where the calculus is a little different in terms of resources. I'm not saying that's a good thing because some of these cases are definitely a little forced, but that really changed the calculus for people on what the risk was.

Chris Madden:
And while privacy has become a much bigger deal, the channels we use to reach people keep multiplying. Healthcare marketers aren't just running Facebook and Google campaigns anymore. They're experimenting with podcasts, programmatic, influencers, TikTok. Anything that meets patients where they already are.

Jessica Holton is the co-founder of Ours Privacy. We introduced Jessica in episode 16 around navigating state level fragmentation. Jessica offers a great example of this shift.

Jessica Holton:
We're seeing more and more with our clients that absolutely, Google and Facebook are the core backbone of a lot of their ads, but we're seeing a lot of success with different ways of getting in front of customers.

So things like podcasts and being able to track podcasts. So a company called Podscribe, we have a really great integration with. We see that increasingly become more of a channel that people rely on, especially as you can do more focused targeting for things like podcasts. And then platforms like StackAdapt or The Trade Desk are also increasing in popularity.

The kind of channel diversification that we're seeing our clients use is growing, seems like by the week, but Google and Facebook certainly continue to be the core destinations. In terms of the platform differences, I would classify them into three categories across ad platforms. First category is they are HIPAA compliant and will sign a BAA.

This is pretty rare for an ad platform because their ability to optimize ads is reliant upon data, and so they are not in the business of being HIPAA compliant and processing healthcare information and probably never will be. Number two is companies that say, okay, we can serve healthcare companies but do not send us health information.

We are not HIPAA compliant. We do not want health information. So it's your responsibility to not send out health information or identifying information plus healthcare information. And then third is ad platforms that are really pushing back against getting this data actively. So not just making it the advertiser's responsibility, but taking it upon themselves to say, you are a healthcare company.

We are not serving you. And the majority of ad platforms will fall into that second category where they say, don't send us health information. It's up to you not to do that and to follow our terms. Meta falls into that third category, which as many of us know, they came out with new restrictions for any advertisers that they deemed to be a health and wellness business.

The restrictions ranged from partially restricted to fully restricted and the bulk of our clients get partially restricted, and what that means is that Meta says you are a health and wellness business. We do not want any information that could be potentially classified as health information, and so we will not accept or optimize campaigns for your purchase events, your add to cart events, basically bottom of funnel events.

And so you need to figure out a workaround or just don't use these and instead use top of funnel events. They've since even further clarified what those restrictions are and really actively trying to not accept any health information. So all of these platforms have different ways of managing this, and we've seen that Meta is the first to really take a stance of actively not only putting the onus on you, the advertiser, but actively pushing against getting potential information that could be healthcare information.

Chris Madden:
Let's get to the core of this whole privacy conversation. Consent. It's the starting point, and with so many tools and vendors involved in modern marketing, managing that consent across every script, every piece of data can get messy fast.

Jessica explains how they're helping companies simplify it.

Jessica Holton:
Our consent management platform lets you manage consent not only for Ours Privacy tracking and dispatching, but for all of your scripts and all of your vendors. So there are two main pieces of consent management. Number one is what scripts actually load and when.

Number two is once consent is granted or not, where does that user's data actually go? The first part within Ours Privacy is you have full control over all of the vendors and when they load based on consent given, so Ours Privacy replaces the cookie banner and is the cookie banner that you see pop up on all the sites and lets you have full control over what users see in terms of language there and accepting all cookies, rejecting all cookies, having a fine tooth on categories of cookies that they're going to accept.

Based on that consent and based on the state that that user is in and what laws you need to comply with, because some laws say that the user has to explicitly opt in before anything can be tracked. Some states say as long as they don't opt out, then tracking can occur. So based on the user's consents and the geolocation requirements, that's what's going to dictate, okay, we are okay to load all analytics scripts and therefore do tracking for analytics purposes.

But this user decided not to opt into advertising tracking, and so we're not going to dispatch out any advertising or track anything related to advertising scripts. So Ours Privacy makes it really easy for you to list out the scripts that you want to block and block them correctly.

When the user has given that consent or not given that consent, there are two other pieces here. Number one is users need to be able to withdraw their consent, and it's really important to not only let users do everything they need to do with regards to consent, giving it and withdrawing it. The other thing that Ours Privacy makes it really easy to do is surface what scripts you already have on your site.

So we have a web scanner that scans your website and tells you, here are all the scripts that you are tracking and what category, and you have full control over what category you place each of those scripts into. So from a UI perspective, we aim to make it really, really simple to go through the steps of setting all of this up.

And the huge benefit of working with an Ours Privacy CMP is that it lives inside the same exact platform that your CDP is in. And so what that means is, talking about the second part of consent management, where does the data go once you've given or not given consent? That's what's controlled by the CDP.

So all of your destinations of data are in your CDP, and you have full control over where each user's data goes based on their consent settings, because the consent is in real time updated on that user, and then immediately dictates if it can actually get dispatched out to an advertising destination or to an analytics destination, or no destinations.

You also have really detailed control over what information gets sent for each event, so it's all in one platform, which makes it really, really straightforward so that you don't have to put together this puzzle of various players doing various things, because inevitably the thing that we're seeing is that lawsuits are arising and cases are arising because of misconfiguration and consent management or consent settings not actually getting honored.

So it's really important that not only do you have the banner and collect consent, but you're actually taking that consent into account when tracking and dispatching, and I know that sounds so yes, obviously, but that's why a lot of lawsuits are happening right now is because that's not happening. So it's really important to actually be able to have confidence that when you're putting this into place, you are truly honoring the consent settings when it comes to tracking and dispatch.

Chris Madden:
And once you've got consent, you need data, especially if you're a marketer. But in healthcare, data is complicated. What you can collect, what you can use, how it can be shared, none of it is straightforward.

Here's Jessica explaining what healthcare marketers really need to make campaigns work and why it's such a challenge in healthcare.

Jessica Holton:
The evolution of tracking for healthcare marketers has taken quite a long journey.

So let's take a step back and understand what a marketer needs in healthcare or outside of healthcare in order to optimize their campaigns. In order to really leverage the full algorithm power that Meta Ads and Google Ads have, you need to share back information with Google and Facebook to help guide their algorithms to know who is the right person to serve this ad, to what campaigns are working.

And so traditionally and still today, in consumer, in industrials, any kind of industry that is not healthcare or a regulated space that needs to really take privacy very seriously, what Google and Facebook – and I'm just using Google and Facebook as examples, this relates to every single ad platform – they want you to install what is called a pixel on your site. It's a snippet of code that gets installed across your entire site and it lets Google and Facebook track all data that happens and all events that happen on your site.

So the user journey is someone sees an ad on Facebook and clicks on that ad and then comes to the website. And because a Facebook pixel is on that website, Facebook can now connect what that user is doing after clicking on an ad. And did they view the page view that you wanted them to view? Did they purchase the product that you wanted them to purchase? Did they book an appointment, and all of that data, because Facebook has the pixel or you have the Facebook pixel on their site, all of that data gets sent back to Facebook, and so there's this two-way data flow where Facebook is able to see what campaigns are working and they're able to match exactly who is doing what on the site so that they can optimize their algorithm to show more people like that more ads so that you can get a good ROI on your campaigns.

The problem with that is within healthcare, of course we're following HIPAA. And HIPAA says that you cannot share personally identifiable health information with third parties who are not HIPAA compliant and who have not signed a BAA with you. And so the problem with having a Facebook pixel on your sites is that you are sharing all of the data that happens and takes place on your site.

It's all identifiable because IP address is one of those identifiers and Facebook also can track form fills with email addresses and you're sending back information to them specifically about what pages someone is viewing, what content someone is watching, what appointments are being booked, and therefore what health information or healthcare is being administered or sought.

So you can't share that information back with Facebook under HIPAA. And so as that was becoming clear and as HIPAA issued more guidance around, you cannot have tracking pixels that share just any blanket information back with Facebook, CAPI or conversions API became a go-to solution. And so what that is, instead of installing a Facebook pixel or Google pixel directly onto your site, sitting on your site tracking everything, you the company are instead sending back specific conversion events to Facebook and Google, and you have much more control over what actually gets sent to those platforms.

And so that was a solution that helps companies get more control and remove identifying information and really be able to, instead of track every single thing on the site, track specific events that you want to optimize your campaigns for.

That is really good from a compliance perspective. From a marketing perspective, it's a really hard thing to get really right because you need to be able to track a user after they click an ad. But even beyond that, maybe they click on an ad, they come to your site, and then a week later they actually do the event. Maybe it's book an appointment that you want them to do, and by that time it's hard potentially to connect that user who books the appointment to the user who clicked on the ad originally, and that's one of the downfalls of CAPI.

The other downfall or challenge with CAPI is in order to make it effective to you, it does take a lot of engineering work, so it takes a lot of dev time to be able to set up, to troubleshoot, to modify. And when your engineering team, tech teams are working on so many different things throughout the company, it makes it difficult for the marketing team and the tech team to align and have the same priority around this tracking, which is so fundamental to marketers. CDPs started being the go-to solution.

CDP sits in the middle of your sources and your destinations. Your sources of data are any events that take place on your site. They could be your EHR. They could be form fills, scheduling tools, any sources of data that users, or any sources of events that users take on your site or in your platforms.

All of that event data comes into the CDP, and that's where you process it and have full control over the modifications before they get forwarded out to your destinations. The really nice thing, in addition to the compliance benefits that you get from this, is that all of your data is flowing through one source or one platform, and so you can control all in one place what is getting dispatched and where, without having to worry about, okay, we have a Facebook pixel, we have a Google pixel, we have a GA4 pixel. We have all these various pixels that we have to administer separately. And instead all come through this one central place that you can then control before it gets forwarded on.

And so this has become the go-to because it's compliant, it gives you full control over what gets sent out, and it takes so much less, if any, engineering time so that marketers who are the core user of Ours Privacy platform, they are the ones that can be in there, make changes that they need to in real time, and get those marketing benefits as a result.

Chris Madden:
That's where CDPs have changed the game. Adam has seen firsthand how smart data systems can let healthcare brands grow, personalize, optimize, and still stay fully compliant. It's not about choosing between reach and compliance anymore. Let's hear what he's seeing on the front lines.

Adam Putterman:
It's tricky because healthcare marketers in particular are put in this impossible situation.

Where they're trying to help people and in order to help people, they need to reach people. And in order to reach people, they have to work within these heavy data intensive platforms or heavy data requiring platforms. And so they're often stuck with this impossible choice of, do I share data I'm uncomfortable sharing, or legally not able to share, or do I wither on the vine because I can't reach the people we're trying to help?

And so I think that more and more we're seeing people adopt sophisticated technical ad setups, including CDPs, in order to not have to compromise and to get the best of both worlds. And I think that's only gonna increase. It's harder and harder to get people's attention.

It's harder and harder to reach consumers. The digital health market in particular is becoming more and more competitive and more and more served by more and more companies every day. And so the need to reach people is only gonna increase or the difficulties.

Chris Madden:
To grow in this space, you can't ignore the trends, especially now when the trends are about trust.

Privacy isn't just a check box, it's the foundation of every successful relationship with your audience. Jessica takes it a step further. She believes a privacy first approach doesn't slow growth. It strengthens it.

Jessica Holton:
Following a privacy centric approach forces teams to be smarter and more respectful in your growth motion.

And so it forces discipline into how you're tracking and how you're dispatching out to destinations and how you're using data in your marketing overall. So I think it leads to clearer data and stronger audiences to target. Overall, a better relationship that you have with your customers. So a few things as to why I think that privacy first approaches can actually be an advantage to marketing teams.

Number one, it forces clarity in your funnel. So if you're relying on just native pixels tracking everything, which at this point hopefully you're not doing, but if you're relying on tracking everything because you have pixels and you have everything going back to all platforms, you are just tracking everything. That is not helpful to you.

Optimizing very clear goals and clean conversion events that actually do move the needle for your business. So having the discipline around taking a step back and working in collaboration with your legal or compliance team and your marketing team helps you to define as an overall business what are the meaningful KPIs that actually do drive the business that you actually do care about, and it will ultimately end up with better, more accurate attribution models.

Because instead of you saying this user probably converted from Facebook, you actually know exactly who opted in and what consent tier they're in and what channel they came from because you built in consent-aware funnel tracking. So number one is discipline. It forces teams to be really clear about what metrics they actually want to track and share with third parties.

Number two, it encourages you to use first party data. So by using first party data and consented events, they are more reliable anyway, so you're using more of your own company data to track consented conversions in your CDP and send that back rather than relying on what feels like sometimes a black box of Meta reporting.

And so you actually can do better optimization because you're optimizing for what you actually care about and not blanket events across your funnel. So you can be really targeted on what it is that you're moving the needle on with your campaigns. Third is you can build a better audience because users who actually consent to being tracked and sharing data back are more engaged.

So you're sending back events for your more engaged users. That is going to have a much better interest signal to these platforms. And so ultimately we see better CAC, better LTV when you are using the data from consented users. And then lastly, more from a high level, you are building trust with your users.

And when users know that you respect their privacy, they're more willing to opt in in the future. And when they feel like you are transparently communicating what you're tracking and where it's going and why, then they're less likely to feel just weird about being on your site or feel like you might be using their data for something that is hidden from them, and they don't trust that and they don't understand that.

Instead, by taking that transparent approach and being really clear on what you are tracking and giving them the option to opt out at any point gives you as a marketer the ability to build that relationship with the user, and I think that's a real asset. If you're trying to hide consent and just skirt by and do what you need to do from a state perspective, you're missing an opportunity to actually build trust and credibility with your potential patients.

Chris Madden:
Adam is on the front lines of this every day, seeing just how fast state privacy laws, data practices, and ad platforms are changing. The rules aren't just evolving, they're splitting. What's allowed in one state might be illegal in the next. And while it's a lot for healthcare companies to juggle, the payoff for getting it right is huge.

Adam Putterman:
So on the first one. We have companies every day now coming to us just concerned about the sheer number of state privacy laws and how different they are, and that's a huge burden for companies that are national and trying to navigate, well, how can we comply with Washington and Texas and California?

They're all saying different things and even just the effort of keeping up with all of the changes, it can be immense. And then the subpoint there is that the states are actually taking action against companies and you're seeing that these laws actually have teeth. They're not just performative or for the sake of publicity.

And then the second is the ad platforms themselves starting to dictate what can or cannot be sent to them. So you have top down and bottoms up, which is very new and interesting. So Meta, LinkedIn, more platforms seem to be following and saying, actually, we're gonna prevent you from sending a certain type of data to us.

So healthcare companies are getting hit from both sides on this.

Chris Madden:
And even with all those challenges, Adam sees the win here. Compliance isn't killing growth, it's enabling it. When you're doing it right, you're not just following the rules, you're opening the door to reach more people with more confidence and more impact.

Adam Putterman:
I love what we do because in the past, one company providing a certain type of care to one type of person, and now we get to enable lots of companies helping lots of people in very different ways. So to me, it feels very direct, and it's this idea again, of you can't help anyone if you can't reach them.

And a lot of companies, particularly because of the compliance requirements, are in that situation where they're sitting there and they know how to reach people, but they technically cannot do it in a compliant and or an effective way, and we get to enable them to do it. So I feel a very direct connection to it, sort of piggybacking on all of our clients who are doing really great things to help people directly, and we get that indirect good feeling.

Chris Madden:
What we heard today makes one thing really clear. Privacy is reshaping digital health. It's not slowing it down. The companies that are winning aren't just adapting to regulations. They're embracing consent based systems, smarter data flows, and cleaner tech stacks that actually strengthen patient relationships.

Because when someone trusts you with their data, they're not just a lead, they're a partner. That's what drives lifetime value, repeat engagement, long-term growth and trust. So whether you're a marketer, a founder, or a lead on a legal team, the opportunity is the same: build with privacy in mind, and you're not just playing defense anymore, you're building a brand people believe in.

Innovation isn't just happening in scaling digital health businesses. Episode 20 shows how hospitals and health systems themselves are rethinking marketing to win patient trust.

Chris Madden:
AI isn't just hype anymore, it's here. It's powerful, and it's already reshaping the way we think about patient acquisition and digital health. From smarter automation to predictive analytics and even creative content generation, AI is giving marketers and growth leaders new tools to scale faster than ever.

This is marketing digital health, and I'm your host, Chris Madden. A lot of people hear AI and jump straight to panic, job loss, doom, loops of regulation, robots taking over. But what if we flip the scripts? What if AI could remove repetitive work, unlock insights you've never had before, and actually enhance the human side of healthcare?

Today we're talking with experts on the front lines of digital health, innovation leaders who are using tech like AI and automation to drive growth, improve care, and get ahead of the competition. Let's jump in with our first guest, Dr. Aabed Meer. Dr. Aabed Meer is a physician and investor. We first introduced Dr. Meir in episode one, when he contributed to our discussion around why marketing digital health matters.

Dr. Aabed Meer:
AI is in many ways already proving its value, especially when it comes to administrative automation. We're still in the early days, but there are use cases, for example, in prior authorization and clinical decision support, where you can see the path of AI adding value.

I would say AI, at least in this moment, should be thought of as a copilot rather than a replacement, and the most successful applications will likely augment, for example, clinical decision making rather than replace human judgment. Now, there are challenges to adoption. You have to think about trust. You have to think about regulatory hurdles.

You have to think about integration with legacy systems, and those are some of the barriers that we are going to have to think through as AI becomes more prevalent in healthcare, and we should expect AI to have an increasing role in healthcare. Obviously, we want to be mindful of how quickly it's adopted and how thoughtfully it's adopted, but by and large, I do think that there are very real use cases that would benefit from AI.

Chris Madden:
I was at a conference recently where a panel was talking about something that really stuck with me, how different our tolerance is for human error versus machine error. We're used to doctors and nurses making mistakes. They're human. But the idea of an AI making a mistake, people tense up right away.

Especially in healthcare, where getting it wrong isn't just a bug, but it could cost a patient their life. That's the tension we're all working through right now. How do we balance excitement about innovation with the responsibility to keep people safe?

Dr. Aabed Meer:
A lot of the time it's about life and death, and so the bar is and should be incredibly high for adopting technologies.

There likely is a certain comfort to be derived with human judgment versus technology. People are people and people are perhaps more likely to trust other people than technology or a black box, and so there's a level of comfort related to what you're already used to. And part of what we are doing as not just an industry but as a society is getting comfortable with that transition.

And even one of the examples that we were talking about earlier, if you think about how people buy clothes, 15, 20 years ago, people had a lot more comfort going into a store, looking at the clothes they were going to buy, trying them on, and then buying them. Whereas today, a lot of folks have gotten comfortable with the idea of just buying things online.

And even during the pandemic, folks were buying entire houses without having visited them in person. And so there's a level of comfort that one gains over a period of time, and in parallel, technology also gets better, and the product or solution that's being delivered is better than what was being delivered years ago.

And so there, that's one component of it. And the other component of it I wonder is, if it's going into something and saying, yes, you are going to have a 1 percent or a 5 percent error rate, maybe accepting that can be a challenge versus assuming that, yes, we can assume a hundred percent success even though you may not achieve a hundred percent success if it's purely human delivered care, for example.

I suspect those are some of the issues that we're going to have to work through and think through as again, not just an industry, but as a society.

Chris Madden:
AI is speeding up innovation. Noah Goldfarb is the director of SEO Strategy at Fire and Spark. We introduced Noah in episode six around content strategy for digital health. And for companies like Fire and Spark, the goal isn't to avoid AI. It's to learn it, test it, and figure out how to use it well. You can't shy away from what you don't understand.

In this space, the teams that experiment are the ones that grow.

Noah Goldfarb:
Our workflow has changed significantly internally within the past few months. We've hired our very first innovation project manager to keep us all on track, so it's a full-time job within our company now. And then we have a new core value, which we're calling Innovate every day, which literally means what it sounds like, which is every day we're trying something new.

And most of those things don't work out. The technology isn't there. Maybe it wasn't the best idea. Maybe there was a reason we're doing it the old way. But overall, we've overhauled a significant number of our core processes and deliverables that we produce for our clients. We were actually also just looking through all of our software expenses, and we probably have 20 new tools now, and we just had decided to cut half of them because they just weren't very effective after testing them.

So there are some things that are largely automatable. One of our awesome analysts just posted the other day within our community, our team, Slack, about the keyword research assistant she made, which since automating a lot of the manual steps that we had to take, literally going into tools like hres and SEMrush, plugging in competitors, downloading their data, formatting it in a spreadsheet so someone can assess it and start to analyze it and understand the information in there.

That's the sort of thing that there's just very little reason to have one of our team members using their precious time pressing buttons when they could be doing the hard work, the human work of actually assessing and developing a strategy for targeting those keywords, for deciding how to prioritize like we've been talking about.

We also feel strongly about the way that AI is used in content creation. So probably the most common thing people hear about or think about when they hear using AI for SEO is okay, we're just going to use ChatGPT, maybe we'll use an API because we're fancy and a Google sheet and we will have ChatGPT write a thousand articles for us and we'll make sure they're keyword targeted.

And what we see there is there are some companies who are doing that and it is absolutely working for them. They are ranking. I would consider that to be a very risky and shortsighted strategy, because what you end up with when everybody has the ability to create content using ChatGPT with the click of a button is a bunch of content that looks like it was created using ChatGPT at the click of a button.

And what that means is it's essentially a race to the middle, because it creates mediocre content. It doesn't create trashy content all the time, but mediocre most often. And so if everybody's creating mediocre content, somebody still needs to show up first. That's what SEO is all about. And the person that shows up first, if Google's doing its job well, is the person that is doing more or doing better than mediocre, doing better than everybody else that's trying to target that keyword.

So in short, we use AI in our content process for topic ideation, for coming up with briefs, even writing first drafts if we have an expert or a professional writer that is then going to take it and make it excellent. We use it for QA, proofreading. We use it throughout our process, but it's just about figuring out, especially within your particular space, where is a human the thing that's going to push this over the top and make it something that stands out from everything else that I'm competing against.

Chris Madden:
Ahava Leibtag is the founder and CEO of AHA Media Group. We introduced Ahava Leibtag in episode four around storytelling and trust. For Ahava Leibtag, AI isn't replacing anything. It's adding value. She sees it as an opportunity to challenge companies to evolve, stand out, and build better systems.

That's the theme we're hearing more and more. AI isn't here to take over. It's here to improve the work we're already doing.

Ahava Leibtag:
I'm actually pretty proud of myself for this one, because when AI first came out, everybody was panicked about what it was going to do to companies like mine, where copywriting was a core skillset that we offered.

When I experimented with it, when you first read it, you're like, wow. And then you start reading it and you're like, Ugh, this is terrible. Like a fourth grader probably could

Kali Arduini Ihde:
have

Ahava Leibtag:
done a better job on this. But I knew almost right away that the problem wasn't going to be with content creation and AI, because I definitely think that there are places where you can use it for that.

I knew that the problem was going to come from search. So the top of the funnel has shrunk completely for a lot of healthcare marketers because when somebody goes to Google now and asks it a question that normally it would've gotten links in response, it's now just getting the answer right on the page and the credit isn't going to the publishers who created all this content, who has trained these large language models on what the answer that they should give is.

So now you've missed out on your educational opportunity. For example, if you used to type in supraventricular tachycardia, let's talk about it, Hopkins would come up and Mayo would come up and Cleveland Clinic would come up and maybe an academic medical center close to you would come up and you would get an article that would teach you about what supraventricular tachycardia was.

Now it just tells you right on the page. So the question is what do you do next? And let's take it even a step further now. People aren't even going to Google. They're going into ChatGPT, and they're going into Perplexity and they're going into Claude. And now you have AI assisted search on the AI mode.

Just came out on Google. What is a marketer supposed to do now? Like literally my top of my funnel has completely shrunk, and so I think it's a really exciting time in healthcare content creation because you're going to have to get bolder, smarter about grabbing people's attention, about educating them, about healthcare concepts.

You're going to have to try to grab those spots on Google, which is going to be a land grab for everybody. But I also think that the thing that people miss is that when people are searching and they just want an answer, that's one thing. But if they're searching because they're looking for care, they're going to keep going and they're going to land on your pages.

And then your pages have to be really well constructed and written so that they're convinced that you are the place to go and you're going to need to have video to support that. And your needs are going to have images that explain what SVT is to support that. So I think the opposite of not needing content anymore.

You're going to need even better content, and you're going to need to be smarter and more strategic about what you're really saying and doing. So there are people that just look at the search element, or they look at the content creation element, or they look at the patient journey element and we've got to look at it all and understand that.

When patients are faced with something, no matter what it really is, when it's in their healthcare orbit, they're feeling scared. They're going to start online because we're just trained to do that with almost everything now. And you better be the one who stops their scroll and gets them to pay attention and say, okay, this is the brand that I want to help me. You got to be thinking about it all. It's just getting more and more, I think, complex, but I think it's also just getting more exciting.

Chris Madden:
Andy Crestodina is the co-founder and chief marketing officer of Orbit Media. We introduce Andy in episode one around why marketing digital health matters. For him, AI doesn't change everything. He's not panicking. He's not reinventing the wheel. He's just asking how it can help him serve his audience better.

That's the part of this conversation I appreciate the most. Staying grounded. AI is just another tool. The strategy, the message, the mission, all that still starts with us.

Andy Crestodina:
It feels new. Everything feels new. We all feel disrupted, but the foundation really hasn't changed. Your prospect's information needs have not dramatically changed their emotional triggers. The story in the life of a person who needs some procedure or healthcare, a person who has a question, the psychology of our audiences hasn't changed, and that's the starting point for everything in marketing, of course, is like, who are they? Where are they? What do they need? How can I help them in that moment?

What AI has done is given us new tools for finding that person, for satisfying that person's information needs. It's very famous for writing, and I'm bored by that. I'm tired. I don't use AI for writing. I don't think that's a very interesting use case for AI. I know that a lot of people are excited to more efficiently produce articles or pages using AI. I worry about them because if you create a page using AI, that is not going to be a very differentiated piece of content at all. In fact, your audience could probably write that same prompt and get that same content.

So for a lot of things, it is really the last thing you should be writing is something that can be written by AI. What I love about AI and my best use cases for it are all analysis. Visitor lands on page. That page is talking about a procedure. What other questions? AI can in seconds. If I train it carefully by giving it the persona or generating a persona with AI, it knows my audience very well. It can tell me in seconds what I missed.

What objections does this visitor have that are not addressed on the page? What questions does this visitor have that are not answered on the page? What proof points are missing? What marketing claims that I make that are not supported with evidence? So in other words, I'm using AI not to find deficiencies. I use it to find deficiencies and then go make that thing better.

Because that person really, they may be in pain, they may be stressed, they may have a lot of, how can I help them if I don't know their point of view? So I think a model for AI for the future will be to just create synthetic members of an audience and then talk to them, show them things, ask them what else they need. What's missing from this? Would you click on that? Are these keywords you use? There are AI startups in healthcare that are, for example, helping train doctors by creating synthetic patients and having the doctors practice their bedside manner on an artificial human. That's going to be a standard way for training and for research in the context of marketing.

Use AI for persona driven gap analysis, and you can get better results from any of your pages or posts or any asset you're producing very quickly because it will either validate that you covered all your bases or it'll point out that there's something important that you missed. Data-driven empathy, that's marketing. AI can help you do that through gap analysis.

Chris Madden:
Andy gives us a good reminder. AI isn't everything. There's still the human element to healthcare and to life that can't be automated. Empathy, trust, connection, live and real experiences. That's what people remember. AI can help support that, but it can't replace it.

So for example, take a page about a cardiologist and the visitor's wondering like, is this, how does the doctor feel about this procedure? Your best answer to that, the best messenger for that message is the doctor themselves. So the ultimate way to answer that question on that page would be to video the doctor talking about their passion for offering that service or performing that procedure. AI can't do that. AI can't make a page that personal or that human.

All the key success factors for content on the internet, it's very visual, it's very structured. It's interconnected with other pieces of content, internally linked to other pages. It's using video. It takes a standard as a strong point of view. AI doesn't do almost any of that stuff. It's far better for helping with planning, analysis, strategy research, not very good at making the thing itself because the thing itself should be very visual, very collaborative, very human, very personal.

My view on this may change, but today, no. I'd say make it yourself. Do it by hand and do it with tender loving care because your visitor really needs your help.

Chris Madden:
Our next expert is looking ahead, thinking about the long-term impact and direction of AI. Callie Arduini Iday is the Director of Ventures and Innovation at Northwestern Medicine. We introduced Callie in episode one around why marketing digital health matters. She brings us back to the heart of it all: patients.

No matter how smart the tech gets, the priority has to stay the same. Taking care of the people.

Kali Arduini Ihde:
In the near term, the next few years, it's going to continue being about AI and how do we make these burdensome processes and these people intense activities that have so many multiple steps and complexities within healthcare and is often operational and process. When you think of prior auths or you think of the complexity between patients, their insurance companies, healthcare providers, everyone, it's just so complex and I think that's where AI is really going to continue to be able to chip away at the complexity and automate where it makes sense.

But to me, the long-term direction is really the concept of personalized and precision medicine and really catering, not just the treatments to me as an individual patient, me with my specific background, my specific lifestyle, my specific neighborhood. Taking that into account as you're developing my treatment plans, but also taking into account the latest in medical discovery.

I've heard all sorts of stats that say that every day, every minute, the amount of medical discovery and new published information just is so overwhelming that no clinician, no physician can know what's out there and what the best potential treatment would be. And that's where I think a lot of technology can do that. Scanning of all the studies that are out there and surface what are the best approaches, and then we can make that available to physicians as they're talking and to patients before they even see patients.

We can just bring all of that information together, whether it's from the electronic health record and it's from the patient's history, or it's from what are the latest discoveries in healthcare that can really cater those first conversations with patients while still making the process easier, but really cater exactly the treatment, exactly what's going to happen to them as a person, as an individual.

Chris Madden:
I was curious how working in digital health and AI has affected Callie personally, how she's balancing the rapid pace of innovation with the very real changes of healthcare today.

Kali Arduini Ihde:
It has certainly made me more aware of all the different ways that technology can help in care, whether that's in fitness and wellness and being able to track and monitor and get recommendations that way.

I will also say less about my health specifically, but just more about how I do the work that I do every day. Being the leader of the team that needs to help the organization understand what ChatGPT is and what generative AI is has made it so that I know how it works and I use it daily. And those kind of tools that you'll hear people say AI isn't necessarily going to replace humans, but people using AI will certainly outperform people not using AI.

And I feel like I am now one of those people using AI to be more effective, be more efficient, do things in a faster way. And I'll say that helps, not just in the work that I do, but in my personal life as well. And so it's great to use these tools both again in the work, but also in my personal life because the same kind of administrative burden that physicians have in the work that they do, we all probably have in our personal lives too, trying to plan a trip or figure out what we're going to do for birthdays or figure out how to write a card or a letter to somebody.

And so again, just using the tools available to take some of that burden off of each of us in our day-to-day lives, and me personally in mine, has also been really great.

Chris Madden:
Now I have the pleasure of introducing a new guest to the series. Crystal Broj is the Chief Digital Transformation Officer at MUSC Health, where she builds, tests and scales technologies that redefine how patients access care. From AI driven appointment scheduling to tech enabled referral management, Crystal is leading one of the most forward thinking digital transformations inside a hospital system and translating innovation into measurable ROI and improved patient experience.

For her, AI doesn't need to do everything. It's best when it clears out the tasks that don't need human to human interaction. The stuff that slows us down. That's how teams get more time back for real connection, strategy, and care.

Crystal Broj:
Our system has been growing quite a bit in the past, I'd say five years. I think it's nine hospitals that we've acquired. We are a rescue hospital system for the state of South Carolina. So if a hospital is going under, usually the state asks us to come in and help that hospital. So that's one of the ways that we've grown.

We're building because like seven people a day move into South Carolina because it's beautiful here, so everybody come on down. With that, they need all the services, including healthcare, and so we can't always hire our way out of this. There's just too many jobs and things to take care of. And so that's really where we see some of these AI tools coming into play, is being able to augment our staff so that you get rid of stupid stuff out of the system and let them actually perform those higher tasks, whether it is higher documentation or the more difficult prior auths or the more difficult phone call where you maybe need to change an appointment.

But if you do that, then you have to move your MRI. And if you do that, you have to get another prior authorization. That's something that really takes a person to do. But if you're calling because you don't remember what time your appointment is tomorrow, you really don't need to talk to a person.

Chris Madden:
I loved Crystal's enthusiasm for AI, especially how she's actually testing it to see where it saves time and improves workflows. It's one thing to talk about innovation, it's another to put it into practice.

Crystal Broj:
Something that I'm super excited about is putting the ability to do AI agents in the hands of our staff, whether it's a back office person or a clinician. Now, both of our key partners, Amelia and notable, have a AI agent builder that we can deploy with our clinicians, and we've done a couple of hackathons with this.

We call it a flow gym, because the tool's called Flow Builder. And we brought in maybe 20 clinicians for a two day session where they learned about prompt engineering. Then they learned how to use the tool and then they built workflows that actually worked within two days. And we had a little contest and there was a winner with the trophy and stuff like that.

But they also are going to have the opportunity to see those actually be turned into live projects. We also did an AI exchange with some of our researchers. Same type of a thing where they don't need to connect to the EHR to, for example, one of the winning ones was prescriptions before hospital stay. So check to see if you had this or this so that they could call you and tell you to stop taking that prescription a week before, for example, because we don't have enough nurses to call and just say, you're on this. Stop and take this, or don't take this.

So that was a win-win, not in production yet, but definitely going that way and a lot more of those types of things where you can actually interact with the patient in other ways, making it easier for the patient. But the researchers is very exciting because they have a lot of things where they have to check against government regulations. They have to check against the protocol. They have to build an IRB and all these things.

Setting up a trial, clinical trial can take hours and hours and hours and hours at a time. And they were able to feed in the protocols and the information and check the latest resources from a government website, hold that all together, and then get a document that they could then tweak.

Of course, they're always going to be a human in the loop and see what the result would be. And with prompt engineering, say, write this as if it's being turned into, I don't know, whatever, CD, C or this or that. So they took a process that could take between six and eight hours, and in two days they built a process that's repeatable, that took, I don't know, five minutes when it eventually ran, saving that time so that then they can do other things, like actually find matches to patients for clinical trials.

We're also piloting a software for clinical trials right now that will actually match patient to a trial, see if they meet the criteria or get tossed out so that then only the smallest list goes to a researcher to see if they qualify based on X, Y, Z criteria. So I think there's still years of AI agents that we can build and we can train people that want to skill up to actually build these workflows and do some of the work that if they all came to me with every single idea, we would never be able to get to them, even though we have a tool, because eight people can only do so much.

But being able to go, oh, you want to be able to notify a patient about, here's a workflow. Why don't you work on the workflow? And then you can do it from there. So I'm very excited about that possibility.

Chris Madden:
Next, I'm bringing Clay Holderman into the conversation. Clay Holderman is the CEO of ea. We introduced Clay in episode 13 around partnerships for growth. He's looking at AI from the health system side, specifically the different tools and platforms that are already being used by hospitals and care teams.

Clay Holderman:
Obvious sweet spot was in consumerism and consumer journey, so we did a lot of work in digital front door. That's evolved today into experience orchestration, which is getting away from, yeah, you can do a registration or you can do a pre schedule and booking, or you can do your forms online. Very transactional to can we actually be predictive and proactive and personalized like a retail experience would be in healthcare.

That will be our traditional types of engagements, but more and more people are coming to us and saying, we are being overwhelmed by the onslaught of new companies, bringing Gen AI to bear with promises, and we're becoming fragmented and it's becoming very, very expensive to manage all of these APIs.

Can you help us? App rationalization. Can you help us with the strategy of our entire digital ecosystem? When do we choose to use the EMR that we have invested hundreds of millions of dollars in, even if their offering might only get 80 percent of the functionality of a best in class startup? And when do we really need to differentiate and invest outside of the EMR or the ERP, the core systems of record so that we can create a differentiation in the market and how we build the business case around that?

Chris Madden:
Tech in healthcare is a different beast. It's not like retail or banking or travel. The stakes are higher, the regulations are stricter, and the systems are way more complex. That's why adopting new technology in this space takes more than a good pitch. It takes a real plan.

Clay Holderman:
For more than a decade, we've been comparing healthcare consumer experience with industries like airline travel, booking, banking, and then the holy grail would be to be Amazon, serving up what's you're most likely to want, or Netflix, what's you're most likely to watch, or Spotify.

Healthcare's long hidden behind complexity and regulation, and we allow consumer journeys to be completely fragmented and we'll say it's in the name of HIPAA or in the name of regulation, and in reality, there is so much more, especially as technology allows us to personalize more. As Gen AI is now full scale in implementation, there's so much more personalization we can do without sacrificing data privacy and security.

Chris Madden:
I asked Clay to dive deeper into how hospitals are adopting the new AI tech and whether this technology might eventually replace the legacy tech stacks that health systems are still running on today.

Clay Holderman:
Health systems have put hundreds of millions of dollars, sometimes a billion dollars into a few core systems of record. And that would be their electronic medical record. That would be their ERP, their enterprise resource planning system. Sometimes their HRIS and these systems kind of dictate the backbone of everything else they do strategy wise, because they either have to API into these systems, interface with these systems, architect around these systems, manage updates with these systems, manage data in and out of these systems, or they have to settle for what those systems are bringing forward.

So we pay a lot of attention to Epic and Oracle Health and what's on their AI roadmap. What will they be bringing forward? Really a lot of business planning around when can you get a real return on investment now for something that might be three to five years to maturity in your core system of records roadmap.

In my experience, the ERPs are bringing forward these automated tools, truly a agentic AI or autonomous decision making inside of the AI at a faster rate than the EMRs actually are, when they're actually able to automate entire complex workflows or strings of workflows in areas like revenue cycle or finance and accounting or human resource administration.

But the role for being a co-creator and not leaving the creation of these really powerful AI technologies is, it's so important for health systems to fill because many of those in tech startups and many of those who are bringing forward the new technologies are nascent in the healthcare environment. They don't really understand the workflows. They don't understand the regulatory complexity. They don't understand the risks involved, and so we need to be co-creating in that space and not just be a receiver and consumer of those technologies.

Chris Madden:
There are a lot of wins coming from AI right now. New efficiencies, new insight, new path to scale. Noah opens up about what he thinks this leads to long term. How will AI actually restructure healthcare as we know it?

Noah Goldfarb:
My prediction is that more and more things like PR, things like online community engagement, how people talk about you, what your reviews look like across various platforms. Those are going to be the kinds of things that help ChatGPT or Gemini or any of these tools determine who to trust and who to show.

What we are doing in that respect as an agency is we're expanding the ways that we help our clients, and that includes online community engagement. So when there is an opportunity to, in a valuable and authentic way, engage in a Reddit community, in a Facebook group, we should be doing so. Again, we don't want to astroturf, but we want to be helpful, be transparent, and just provide valuable information and hopefully in doing so, build the awareness and also the perception of that brand online.

Also, it's been a cliche for a while, but search is changing beyond just text. So video and audio and graphics are becoming more entwined with the way that people search across different platforms. Lots of people search on TikTok now. How are you showing up on TikTok? Is it just that you're producing videos that you think are interesting? Is it that you're doing an influencer marketing strategy?

No matter what it is, if you have video assets, you should be leveraging them as well as you possibly can. That means creating awesome content that shows up well within TikTok, but also being able to repurpose those assets so that they're showing up well on YouTube and Instagram and Pinterest and any other platform. And on your website and in Google search as well.

I think there is going to be a lot of overlap in what SEO looks like and what people have called it, GEO. We prefer the term organic demand generation, which is just organically, however people are searching across the web. How are you getting in front of them? The way that you're showing up across the web and demonstrating your trust across the web and authenticity and engaging with actual people is going to become more and more important.

Chris Madden:
Noah shifts gears back into SEO and what AI might mean for search content and digital discovery in the years to come.

Noah Goldfarb:
I think that people on both ends of the SEO forecasting spectrum are wrong. A lot of people who are very dour about SEO are overly pessimistic. And the reason I think that is people are going to continue to search. Like the size of the pie, so to speak, to use a marketing term, is not shrinking. If anything, it's going to be growing.

There's going to be more searches performed, more people looking for information in more ways. If you're going to ignore that and just say ChatGPT, if Gemini, if they choose to show me, great. But if not, they can show my competitors. I think that's going to be a long-term mistake, because people are still going to be searching for information when they're making conversion decisions.

So that's why I'm not so pessimistic about the future of SEO. On the other end of the spectrum, there's the people that are then SEO is going to continue pretty much exactly as it has. Or what they'll say is we need to rethink SEO in a way that actually takes the onus off of SEO. What you'll often hear is people saying the new metric you need to care about is visibility or the new metric you need to care about is impressions because fewer people are clicking through to websites.

The really valuable KPI is just getting shown, and I firmly disagree. It's great to get shown. You'd rather show up somewhere than not show up there. But I think any kind of marketing that runs away from accountability to actual business growth is just going to be less essential to business overall.

So I think the answer is that SEO is going to change, probably quite dramatically. And the way we think about optimizing for search is going to change, and the activities we do are likely going to change. It's like it's still going to need to be about content creation, high value asset creation. But over time, as we get better data, as the tools improve, we're going to understand, and very importantly, as people change the way that they search for information, so it's not just the tech changing, but search behavior changing,

We're going to get a better understanding of the new way that decisions are made and the impact that could have on the day-to-day activities of an SEO could be fairly minimal, but it also could be fairly dramatic. The test that I have in my head is what I call the my mom test, which is I am waiting for my mom to tell me that she is using ChatGPT or the one of those nifty little answer boxes at the top of Google to make any sort of conversion decision in her life.

And I think that's interesting because marketers, we think about this all the time. We're probably already using these tools when making conversion decisions, but we are not representative of the majority of the public. Once the majority of the public starts adopting these tools and doing so frequently, we're going to get a much better understanding of how their decision making is changing along with the technology.

And then the last forecast I'll make is there's been a lot of concern about ChatGPT in particular. That's probably the LLM with the biggest name recognition. My money is going to be on Google until they give me a reason to not put it on them. So the thing I'm watching most closely at the moment is the recently rolled out, I think it's in beta still, AI mode, which is essentially an AI overview that you can chat with.

It's nothing too fancy right now, but if you had to put your attention on one single tool to understand what SEO is going to have to be about over the next year or two, I'd be watching what Google does with AI mode.

Chris Madden:
And that's a wrap on today's episode. We heard from leaders across the industry embracing AI, not as a replacement, but as a catalyst. It's a way to unlock smarter decision making, scale, operational efficiency, and personalized patient experiences like never before.

Whether you're a marketer, products leader, or founder, the message is clear. The teams who lean into AI now through experimenting, refinement, and application won't just keep up, but they'll lead. And the best part, you don't need to go all in overnight. Start small by automating a workflow. Use AI for creative testing. Build smarter targeting with AI.

Do whatever you can do to get closer to your audience in a faster, more meaningful way. Because in healthcare, growth isn't just about volume, it's about connection. And AI is becoming one of the tools that makes connections scalable without losing the human touch.

But AI isn't the only shift. Episode 19, our next episode, looks at consent based infrastructure and the technical pivots needed to build privacy first, sustainable growth.

Chris Madden:
Have you ever had a campaign ready to launch, only to have it stalled by legal, or maybe you're a lawyer yourself and you're continuously reigning in creative ideas that feel just a little bit too risky. If that sounds familiar, then this episode is for you. This is Marketing Digital Health, and I'm your host, Chris Madden.

Today we're unpacking one of the trickiest dynamics in digital health, which is how marketing and legal can actually work together instead of against each other. Two teams that don't always speak the same language, but absolutely need each other to succeed.

This episode features Kaitlyn O'Connor, a new voice to our series. You'll hear familiar guests like Chris Turitzin and Rebecca Gwilt. Today's guests are yet again here to guide us with their expertise so you can learn how to navigate the complexities of staying compliant without being held back.

Kaitlyn O'Connor is a leading voice at the intersection of law, innovation, and healthcare, and is the co-founder at Elevare Law. As an experienced healthcare regulatory attorney, she guides digital health companies through the fast evolving compliance landscape, ensuring that growth and innovation happen within regulatory boundaries. Her perspective is critical as health tech companies scale patient acquisition, integrate new technologies and face growing scrutiny.

Elevare Law was created with the intention to break barriers and build the new future of healthcare. They typically work with really motivated, personally invested founders in the healthcare space whose vision of the industry aligns with their own. Their goal is to make healthcare better, more accessible, more equitable, easier to get, and less expensive.

Kaitlyn O'Connor:
So I think that simple in particular, is actually not how healthcare regulations and laws exist. They are very complex. They are not simple. They are in many cases very old and have been around for a really long time, which means they haven't kept up with innovation.

So what our approach is, is we will take complex topics, distill them down into two or three important talking points, and also include very actionable recommendations. For example, if a client comes to me and asks me a question about a particular marketing referral arrangement that they want to set up, my initial response is, that's probably going to implicate the Anti-Kickback Statute, let me put together some thoughts on it and then let's talk through it.

And then my response will be, okay, under the Anti-Kickback Statute, you can't structure this exactly how you proposed it to me. Here are three ways that the government has said you can structure these types of relationships and here are the things that I recommend you put into place in order to better align with the way the government has approved this kind of thing, and also just making sure that those recommendations stay aligned with the goal that the client has set out.

What we hear from clients a lot is, when they've been working with other law firms, a lot of times they've spent several weeks, several months asking the same question to their other lawyers who have just said, no. They've said the Anti-Kickback Statute doesn't allow this, and then they don't follow that up with specific recommendations or specific examples of ways that they can achieve the goal they've established.

And so we try to do that in a clearer way, and we do that in a more efficient way by leveraging AI and other types of software tools that augment our experience and our knowledge and just help us draft contracts faster and analyze certain legal issues, that kind of thing.

Chris Madden:
Working with our legal team means having real expertise on your side. People who understand the pace of healthcare and the language that comes with it. Elevare Law helps their clients evolve and grow inside one of the trickiest landscapes out there. It's not about slowing innovation down, it's about finding the safest way forward. That's how you build a company that lasts.

Rebecca Gwilt is a healthcare regulatory attorney and co-founder of Elevare Law. We introduced Rebecca in episode 15 around privacy and compliance in marketing.

Rebecca Gwilt:
It has allowed us from a business perspective to understand and more easily adopt and take advantage of the evolving technology solutions that are out there, having nothing to do with healthcare in particular. That's been really fun as we have built this business.

And it has allowed us to serve not only as experts in what the law says about partnerships and data sharing and building businesses and reimbursement and closing commercial deals, but also the ability to look out across the industry at trends, at the sort of evolution of policy and really serve as partners with our clients who are trying to figure out problems that nobody's solved before.

So I would say yes, we do the nuts and bolts of, we help you with contracts, we help you start your business, we help you grow your business, we help you close deals and stay out of trouble. Our best work as lawyers is serving as strategic partners for our clients in creating that which does not yet exist in a way that's sustainable and mitigates risk for the company.

Chris Madden:
I love how Kaitlyn got specific and personal here. That story about the client stuck in months of no answers, it's a great example of why having the right legal partner matters. Elevare doesn't just stop at what can't be done, they find creative, compliant ways to move you forward.

And up next, we'll hear more about what a kickback really is and how to avoid it before it becomes a problem.

Kaitlyn O'Connor:
Recently I had a client that came to me. They had been working with a nationally recognized healthcare law firm for several months, trying to identify a way that they could coordinate care between primary care providers, hospice agencies, and home health agencies.

And how could they do that in a way that was low cost to all of the stakeholders that they were working with, low cost to patients, affordable for the providers, added value for the hospice and home health agencies that they were working with.

And one of the ways they wanted to do that was by providing their services for free or at a significant discount to the providers that they were working with, to the hospice agencies, to the home health agencies.

Providing services to an entity that bills Medicare — which in this case all of the entities they were working with bill Medicare — traditionally providing services for free or at a very steep discount to entities that bill Medicare is a kickback, particularly if you're doing something that contributes to whatever they're billing for.

So if you're providing a service that facilitates a form of remote monitoring that the provider can then turn around and bill for, if you provide that service for free, where the provider or whoever you're working with would have to pay for that service if they were to work with someone else, that's a kickback and you're not allowed to do that.

And so they'd been hearing, no, this client had been hearing no a lot from the other law firm that they'd been working with. They'd spent thousands of dollars, countless hours talking to attorneys, having attorneys research the issue, and they came away with a, no, you can't do this, here's what the law says, go figure it out and come back to us with a new proposal.

When they came to us, we said, okay, the way you want to set this up as you've proposed it to us, yes it does implicate the Anti-Kickback Statute. The way you want to set it up is probably not permissible under any of the applicable safe harbors. However, there are a couple of new value-based enterprise safe harbors that were just introduced a couple of years ago that most healthcare lawyers that I know haven't really found a way to leverage yet, but I think this is a perfect way for us to leverage it.

So let me put together a model diagram for you. Let's get back on a call and talk about all the things you're going to need to put that in place, make sure the plan that I put together for you still aligns with your overall goal, right, which is adding value for these various entities that you're working with and making sure it's seamless for patients to go from a primary care provider to hospice and leveraging the technology you already have to make that process seamless and to add that value that you want to add.

And we did that in a matter of, you know, probably a week. And we went back to them, we set it up, we explained how it would work. They said, this is exactly what we're trying to do, let's do it.

And within a month we had everything set up, and now they're out in the world providing exactly what they set out to provide in a way that is compliant.

It's so important when you have a new strategic idea for your company that you know will require marketing to make sure that you have providers that want to participate in this model. But it's why thinking about compliance is so important to actually keep you moving forward, so not as a way to slow you down, but as a way to create a competitive advantage, create something new that most other companies in your space haven't figured out yet, and go out into the market and be the first one to do it.

Chris Madden:
Kaitlyn mentioned how value-based care regulations are still relatively new and how few companies have really learned how to leverage them. She walks us through where they came from and why they matter.

Kaitlyn O'Connor:
Historically, the Anti-Kickback Statute has been very prohibitive to growth initiatives, because the Anti-Kickback Statute prohibits paying for referrals of patients that are covered by federal or state healthcare programs.

Interestingly, after several years of industry stakeholders talking about this, the government said, actually, we think you're right. We do see how the Anti-Kickback Statute, as it currently exists, could be prohibitive to some really important, really valuable services that you stakeholders want to provide to patients.

So we're going to set up a set of safe harbors called the Value-Based Enterprise Safe Harbors. There are three key safe harbors, and essentially what they've done is they've said, we have outlined three types of business arrangements that traditionally would have violated the Anti-Kickback Statute, but if you do them in this very specific way, we actually think it's okay because we can trust that the value that you're delivering for patients is going to outweigh any extra cost that Medicare has to pay, or extra cost that the government has to foot the bill for.

And those three safe harbors, just to simply state them, one is for care coordination arrangements. So that's where you have a company that is coordinating care between multiple provider entities, which is similar to a situation where a company is facilitating care coordination between a primary care provider and a hospice agency and/or a home health agency.

They're taking patients from that primary care provider. They're using an algorithm to identify and stratify risk across the patient population and pull out the patients that need to go to hospice. Pull out the patients that can probably actually go to home health first before they go to hospice to delay that timeline before they actually need hospice care.

So that care coordination safe harbor allows for you to do that at a very, very steep discount of your services so that the providers that you're coordinating this care for don't have to take on a bunch of upfront risk in paying for your services without really getting much upside, because they're not billing for those services. You're just taking patients and sending them somewhere else.

And so it allows you to provide those services at a discount and potentially share in some of the upside where traditionally under AKS sharing in upside is, again, a kickback.

So that's the Care Coordination Safe Harbor. The key difference between that care coordination safe harbor and the two other safe harbors I am about to mention is that the care coordination safe harbor limits any type of remuneration to in-kind remuneration only. So you can't give a cash kickback to the providers that you're coordinating care for, but you can provide, for example, medical devices to their patients for free that they don't have to pay you for so that they can monitor their patients' blood pressure on an ongoing basis and help you identify that risk sooner, intervene earlier, that kind of thing.

The second two are what I would refer to as sort of risk-based safe harbors, which allow for entities that are participants in, or have partnerships with participants in, value-based reimbursement models with insurance payers.

And in those two instances, there's one where an entity takes substantial downside financial risk, and then there's another example where the entity takes full downside financial risk. And basically those safe harbors say if you are taking on some of this risk that the company you're working with is taking on from a payer, or if you're working with a payer who takes on a lot of downside risk and you share in that downside risk, you can also share in the upside if you create savings for that entity.

So again, where the Anti-Kickback Statute traditionally prohibits any kind of cash remuneration or kickback, in this case, if you work together, you both take on that downside risk together, whether it's most of that downside risk or all of that downside risk, you can then share in the upside that they get under those value-based payment plans.

So if you take on that downside risk, you save a bunch of money for them and they get a big payment because you've saved a bunch of money, they can pay you a piece of that margin. The facts always matter, but it is a relatively new way that regulators have provided additional flexibility under the Anti-Kickback Statute that before two or three years ago didn't exist.

Chris Madden:
Next, Rebecca takes us through the general lifecycle of a telehealth company from building compliance structures to figuring out how to get paid. This is where legal meets real-world business strategy. You'll hear how companies navigate red tape, get creative and still manage to scale.

Rebecca Gwilt:
It is create a compliant infrastructure that I can use as a person who's not a physician, as a venture-backed startup, as an entrepreneur, tech entrepreneur. Create for me the infrastructure that will allow me to be in the business of telehealth. That is your MSO-PC structure.

Now, way more than it was a couple years ago, clients are coming to me saying, I know that's the minimum of what I need. Great. So now that you know that, now you know how to build that, and there are a number of ways to do that.

Then you go, okay, well now I've done this, right? Now I've got to figure out how to get paid. And it was easy to start out with to get a Stripe account and get people to charge their credit card and come buy telehealth. But the really big market is in the payer space, because most people in this country still want to rely on their insurance to pay for their healthcare.

So the way I get access to a lot of people is I’ve got to get into the payer contracting space. And that can take a lot of time. That can take three to six to twelve months depending on what size of the organization you are, to go from an all cash pay to a, I've got a national contract with Blue Cross Blue Shield and starting to credential physicians.

And so one of the creative ways that people are getting around that is whole businesses have cropped up where they are signing contracts with national payers and they are creatively leasing that to other telehealth companies.

Now, whether that's going to be a forever thing or whether the payers are going to get down with that, remains to be seen, but it is a, it filled a need. Companies across the industry said, it's too hard for me to get contracts with every single state, with every single provider and the good rates, because when you start out, you don't have enough people to negotiate, etc.

What if there was some big company that got all the contracts and then allowed us to piggyback on those contracts? From a legal perspective, very, very tricky. But from a business perspective, this is what comes to our desks as innovation attorneys, right? Can we do that?

And I think traditional lawyers would say, well, that seems very risky and I've never seen that before and probably no, and the hard job is trying to see in which ways you can make that happen contractually, legally, from a regulatory perspective.

The other thing that has happened is companies that want to provide a service to individual consumers who don't have a network, but want to sell to independently practicing practitioners and create leverage by pulling a bunch of independent practitioners together in some way, those businesses have emerged.

ALMA is a good example of this. Headway is a good example of this. These companies that are figuring out a creative way to concentrate the power of individual practitioners as if they were a healthcare provider themselves.

Corporate Practice of Medicine issues, fee-splitting issues at the state level, Anti-Kickback issues if you're in the Medicare/Medicaid space. So all of these are reactions to the constraints that the very early sort of big crop of telehealth companies faced and their executives said, well, this shit sucks, like how do we get around this? This doesn't make sense. All I want to do is provide healthcare to all these people, why all these barriers?

And so it forces that strategy discussion. It's really about hitting barriers as a business trying to grow now that there's so much private money running through healthcare, and forcing people like me to go, okay, well that makes me uncomfortable because I've never heard it before, but, okay, well what if we did it like this?

Chris Madden:
We've talked about how the legal landscape keeps evolving. But here's the flip side. A lot of these rules are old, decades old. HIPAA, TCPA, CAN-SPAM. They weren't written for the digital world we live in now. Companies like Elevare help founders navigate that tension between old laws and new tech. Kaitlyn shows how knowing the law gives her power.

Kaitlyn O'Connor:
It's important for digital health companies, particularly when they're building out a marketing strategy, but really in all phases of building and commercializing a new business in healthcare, it's really important to understand that most, if not all, of the legal and regulatory landscapes that are going to apply to you are going to be very old.

For example, HIPAA was first published in 1996 and it hasn't really changed very much since then. TCPA, very old law that has not really changed much since its inception. TCPA applies to automated telephone calls. Most of my clients aren't really calling patients anymore, but TCPA could implicate text messages that you might want to send to patients, for example.

CAN-SPAM, which has to do with email marketing. FDA medical device regulations. The FDA has done a good job of publishing guidance, but they have not necessarily updated the actual FD&C Act. Many people who are listening might be familiar with the 21st Century Cures Act, which is the most recent version of that, the most recent update to the FDA's medical device regulations.

But since then, it's really just been a lot of guidance around software, AI, that kind of thing, and then other state-specific laws as well. Corporate Practice of Medicine rules tend to be pretty old and actively enforced, and state licensure laws, state tele-prescribing laws, which were largely created during the height of the opioid epidemic and haven't really been updated now that we're living in a much more virtual world than we were back then.

Most of the laws in the healthcare world are pretty old. They're pretty complex and it's not that easy to update laws, but it is pretty easy to update technology. Technology is evolving fast. Yes, there's a lot of work to do on the product design and development side, but generally speaking, technology evolves a lot faster than regulation.

And that means that when you build out your strategy, when you build out your product, you have to think about compliance with those laws, and you have to identify the areas where you can push the boundaries a little bit, understanding that the laws are old and maybe haven't been updated to apply directly to what you are building, and then build a strategy around that as well.

Chris Madden:
And while the laws themselves may be hard to change, they also can't be ignored. Kaitlyn's point about thinking compliance into your design phase is so important. If you wait until launch to think about regulations, you're already behind. Building compliance early saves you from costly mistakes later, and it's what separates startups that scale from those that stall.

Kaitlyn O'Connor:
Before you build a product that you want to go to market with, there are a lot of regulatory pitfalls that you should be aware of and that you should build into your product design, if it's a product that you're designing, or your services design, if it's services that you're selling.

For example, the FDA is going to look at essentially two things when you go to market. They're going to look at your marketing language and they're going to look at the actual functionality of the software platform or the medical device that you are selling in the market, and they're going to look at those two things to determine whether what you are building or selling is a medical device, and if it is a medical device, whether it requires some form of pre-market clearance or approval or registration or not.

And where I have seen many companies forget about this or not take this into account is going to market and then going to build revenue so that they can afford FDA compliance, but now they've already gone to market with a product that needed to be approved by the FDA before they went to market.

And that's going to make the process of going through the FDA clearance process, the process of going through the FDA approval, much more difficult because you're already coming from a place of where you've potentially not been compliant. So I think it's very important for very early-stage companies to build compliance into their design.

But I do also think that scaled companies who have already achieved growth should think of compliance as an ongoing strategy.

Chris Madden:
Chris Turitzin brings up something that ties this all together. Rigor, the constant pursuit of truth. In marketing and healthcare, that means being obsessed with accuracy, data and what's real. It's what builds trust. It's what protects your reputation, and in this space, trust is everything.

Chris Turitzin is a growth advisor for digital health companies and is the founder of Single Aim Marketing. We introduced Chris in episode one around why marketing digital health matters.

Chris Turitzin:
I would just describe rigor as essentially the constant seeking of truth and a constant having of a very high bar for what truth is. What that often means is just everything you do has some form of data associated with it, and that data has like a strong basis behind it, like an intellectual basis for understanding what is actually going on.

Everything in the world generally can be described as some form of mechanism or machine, and usually that mechanism can be described through some form of dashboards and data and things you can observe.

That's what I mean by rigor, is trying to understand the mechanism behind something, understanding the levers that you can pull and ways that you can measure what the impact of those levers are.

What that turns into is a bunch of dashboards, a bunch of metrics you're constantly watching, metrics you deeply believe in, and also experiments you're running to see if those things are working. That's how I describe rigor, and I actually was having a conversation with someone recently about this and I was like, is rigor constitutional or is it something that's learned?

Chris Madden:
When you're working through your marketing funnel, there are safe and unsafe ways to collect and share information as it relates to marketing and advertising. We've touched on this in previous episodes, but now we're bringing the lawyers into the conversation.

Rebecca maps out a clear three-step process to help companies stay ahead of HIPAA and FTC rules before anything ever becomes an issue.

Rebecca Gwilt:
So the process generally starts with an awareness stage. This is an anonymous visitor. This is a person Googling and landing on a web page. This is definitely outside of HIPAA territory. After the GoodRx case, my guess would be, depending on what your privacy policy said, FTC is not so worried about it.

The main guardrail here would be FTC. So the company would want to make sure that their privacy policies are accurate in terms of what they're doing in marketing. So you're on the page, you're browsing, you're looking at things, and of course information is being collected on the website about that.

How many times did you click on this? What ad did you click on? How long did you spend on the page? All this information is being collected, and that should be reflected in the privacy policy.

And while marketing teams should tread carefully in that space and err on the side of caution generally, this is a safe space until, as OCR has said in the past, you get to a space where you have something identifiable and that is indicative of someone accessing healthcare.

And that's usually at the engagement stage, right? This is a browsing stage. This is engagement. This is when someone is providing their personal information, taking a quiz where you are connecting their identity with the IP address that you have or whatever information from their device, if it's a mobile app.

At this engagement stage, that's when the user generally becomes identifiable, and that's what you're looking at. And at that stage, we're in a gray area, and I think that's exactly what you're mostly dealing with with your clients.

You understand that once they are in an authenticated environment, that's protected information. You've got to be very careful. You know that when they're browsing, you're probably fine. You've got IP address, not much more. You've got information about the activity of random people on the site or in the app.

This middle stage of engagement is where it gets tricky, and what I like to tell folks is, when does it become identifiable? Because it doesn't matter if it's healthcare-related if it's not identifiable. And once it's identifiable, when are we really talking about enough of a nexus to access to healthcare, the prior receipt of healthcare, the status of your healthcare, when did that start to happen?

The other variable I would suggest thinking about is the sensitivity of the information that's being collected, because practically the federal government, with limited resources, is more likely to come after a BetterHelp that is collecting and sharing information, sensitive information about people's mental health status, and GoodRx, which is collecting and potentially sharing information about people's medications that could indicate some very sensitive disorders they may have, than it is a less risky use case that might still be on the edge.

So this is all analysis, and this is why it's really important for legal and marketing to be sitting together at the table, for marketing to be very carefully reading the privacy policy and saying, yep, this aligns with what we do, or we actually use it for these other purposes. This says we don't. The marketing team needs to be reading that, not just the lawyers.

The lawyers need to be invited to the conversations about the evolution of this tracking technology, what tools are being used now, what intermediary technologies are now available to de-identify information and take the sting out of some of the limitations that are imposed by the law.

It is a good best practice in companies that when their advertising and marketing people are about to launch something, whether it be tracking technologies or whether it be language on the front page of the website, they should be working together with their internal compliance folks at the very least.

Chris Madden:
It's not just about hiring a lawyer. It's about hiring the right one, the kind that understands both healthcare and growth.

The companies that win are the ones that stay proactive through updating privacy policies, embedding legal in the workflow early, and making compliance part of the creative process. That's how you grow confidently without getting caught off guard.

Rebecca Gwilt:
The goal is a practical partnership between legal and marketing. The goal is an experienced and educated marketing team. One of the ways that you can ensure that, one, is making sure you hire experienced folks who understand the healthcare space, healthcare data privacy.

Make sure that you have a healthcare data privacy officer who is consulting with them if they do not have interest, and if they do not have experience in the healthcare space regularly. Making sure that they are receiving training on this regularly. Making sure they're reviewing the privacy policy and updating it if things have changed.

It is also a best practice to embed compliance in the marketing workflow. Much like the sales teams, marketing teams often don't want to bring legal in because generally legal is the one that says, hold up, slow down, can't do this, come explain it to me, don't want to talk, don't launch it until we've talked about it. And so legal is really seen as a barrier in the workflow.

But if they're integrated from the beginning, if at the beginning of a campaign you said, we want to do this, here's what we're thinking, and legal could go, great, as you're building it, here are some things to keep in mind and make sure that you've reviewed this policy, you don't get the bottleneck at the ninth hour when you're supposed to launch this on Monday, and the CEO is going to be down your throat if you don't get it done.

So embedding legal early on in the workflow is another best practice, and not just educating the marketing people, because I don't want to put it all on your shoulders, but making sure at the leadership level of these companies that there's somebody that's paying attention to comms and marketing that has the CEO's ear that legal can go to and say, hey, when you're about to launch this really sensitive information here, your sales team needs to know about this, your product team needs to know about this, your marketing and advertising team needs to know about this, and we've got to bring legal in.

That way, you have consensus among the leadership that this is an important thing. And as we've seen from a couple of actions, not just GoodRx and BetterHelp, but Premom, and it's continuing to happen, there are more actions coming out, these are existential threats to a company. Multimillion-dollar settlements, and the inability to, without a HIPAA authorization or a detailed consumer authorization, being able to share information to target your advertising is a real handicap for companies.

It seems like one of a few very small things to pay attention to. It's actually quite important.

Chris Madden:
Rules matter, and they apply whether you realize it or not. Kaitlyn makes a great point here. If you're selling in healthcare, you need a regulatory and reimbursement strategy from day one, because if you're not planning for coverage and reimbursement, you're cutting off access to the patients who might need your product or service the most.

Kaitlyn O'Connor:
Many, many, many patients and providers will not be willing to or will not be able to afford your product or services if they cannot leverage insurance reimbursement as payment for those services. Patients don't want to have to pay out of pocket. In many cases, they cannot pay out of pocket.

Providers don't want to have to take on a bunch of additional costs to pay for your services that they don't necessarily get upside for by being able to get reimbursed for using your technology.

So I think that at the design phase and at any growth stage, whether where you're building out a new business line or considering a strategic pivot for your company, I believe that companies should be thinking about how the regulatory landscape interacts with their reimbursement strategy and how those two things work together to help them be successful in the market.

For example, I have recently had a number of companies come to me with established FDA strategies. They've already gone through the FDA approval process. They come to me and they say, we got clearance, we're ready to go to market. How do we get reimbursed for this product? Or how do the providers that we sell to get reimbursed for this product? Or how can we get reimbursement from insurance payers for the patients that we sell this to?

And what a lot of those companies that come to me don't realize and haven't taken into account through the entire FDA process is that the language that you use, the way that you conduct your clinical trials is very important, and it will impact if or how you can leverage reimbursement at the commercialization phase.

Chris Madden:
And when it comes to navigating the FDA process, language matters. The smallest detail in your submission can shape how your product gets used or who could even use it.

Kaitlyn walks us through how that plays out and how easy it is to trip up if you're not thinking long term.

Kaitlyn O'Connor:
If you go through the FDA process and you, for example, tie your software to a specific piece of hardware, you may come out of your FDA clearance really excited because you've got your approval and now you can go to market, but then you're going to go to market and there are a lot of patients that don't have that piece of hardware that you included in your FDA submission.

And so now you actually can't sell your software to anyone with a different type of hardware. So if you build a product that works on an iPhone and you go through the FDA clearance process and you demonstrate how your software works on an iPhone specifically, the FDA may very likely say, okay, we approve this for use with an iPhone.

But for Android users, this hasn't been approved yet, and you need to conduct more trials that involve an Android and show us that it's safe and effective for use on an Android.

And then when you look at the reimbursement phase, the reimbursement might say that the product that you are using that CMS, for example, is going to pay for — and I think about this more specifically in the context of remote monitoring. Remote monitoring involves collection of data through medical devices, automatic transmission of that data to providers who monitor that data on an ongoing basis.

I have a lot of clients that develop software and/or hardware to facilitate remote monitoring, to collect data from patients, to transmit that data to providers for their provider customers to review on an ongoing basis.

And those reimbursement codes, the remote monitoring reimbursement codes, require that the provider is providing to the patient a medical device that collects the data and transmits it to the provider. So an Apple Watch, for example, not a medical device. Your provider cannot get reimbursed by Medicare for an Apple Watch that collects data.

So if they're only getting heart rate data from your Apple Watch or only getting step data, pedometer data, from your Apple Watch, they won't be able to bill the reimbursement codes for remote monitoring, for monitoring that data.

So where this sort of overlaps with your FDA strategy is, if you have an approval from the FDA that says your software is a medical device and it's approved for use on an iPhone, if you sell to providers whose patient base has a bunch of Android users, your providers actually won't be able to use your product for those Android users.

And they won't be able to bill the remote monitoring codes for monitoring the data from those Android users, even if your product works exactly the same on the Android phone as it does on that iPhone.

Chris Madden:
That's where the AppliedVR example really shines. They didn't just check compliance boxes. They turned regulation into a competitive advantage. By aligning their FDA and CMS strategies, they secured a brand new reimbursement code that locked in their leadership.

That's smart and strategic compliance. It's what separates innovators from imitators.

Kaitlyn O'Connor:
They conducted trials, they submitted documentation to the FDA that demonstrated that their software is safe and effective on a specific type of virtual reality headset that would not necessarily qualify for remote monitoring reimbursement when it's used on a different type of VR headset.

But what they then did was they then went to CMS once they got through the FDA phase and they said, hey, CMS, check this out. We created this software platform that works really well on this specific type of VR headset, and therefore it's actually hardware and software combined.

And so we think you should create a new Durable Medical Equipment (DME) code, a new DME reimbursement code. And they did that successfully. CMS created a brand new code that only applies to this software operating on this specific virtual reality headset, and that does two things.

One, it ensures that providers can use the software because now the company's providing both the software and the hardware. But secondly, it's a huge competitive advantage because any of their competitors that are creating a similar platform that doesn't work on that headset or that isn't called RelieVRx — that DME code that AppliedVR got created won't apply either.

So here's where I think it's important to think about a comprehensive regulatory and reimbursement strategy, because one, you want to be able to leverage the reimbursement codes as broadly as possible, and you want to make sure your FDA documentation supports that use. But also, it can be a competitive advantage, because if you are creative about it and you do it in a specific way, then you can prevent other competitors from being able to leverage that code that you've just spent seven, eight years and millions of dollars to get to.

Chris Madden:
Even if you think certain rules don't apply to you, you might be wrong. State laws can classify your company differently than you expect.

Kaitlyn's story about the SaaS business that accidentally crossed into Corporate Practice of Medicine is a perfect reminder that what's compliant in one state can get you fined in another.

Kaitlyn O'Connor:
Another common pitfall that I see with my clients is not understanding how state law will classify what you are doing. So you might think, hey, we're just a platform, we're just a software platform, we don't provide any clinical services, but we hire physicians and staff them to health systems. So we don't need to worry about state licensure rules.

We don't need to worry about Corporate Practice of Medicine prohibitions. That's on our customers to understand. And that's not always true, because if your website says something that implies to a particular state medical board that you do employ physicians, it may be the case that you actually are required to comply with corporate practice rules, even if you don't believe that you are providing treatment.

The state law might actually say that you are, and it's important to understand that.

A client came to me. They said, we're a SaaS business, we're just a platform, we're not involved in care delivery, but we do hire physicians and nurse practitioners and staff them to our customers in these five states. And in three of those states, the law said if you hire physicians, if you employ physicians, whether or not the entity itself is providing medical services, if the entity is hiring physicians, that is the practice of medicine and you are therefore subject to state Corporate Practice of Medicine laws.

And you have to set up a professional corporation that is owned by a physician, and you are a tech company that has a bunch of VC investors, so you're not compliant. And so we had to backtrack very quickly and redo their whole corporate structure to make sure they were compliant with those corporate practice prohibitions.

Chris Madden:
As we've explored in previous episodes, state-by-state differences can trip up even the most experienced founders. A strategy that's perfectly legal in Arizona might not fly in California.

That's why every expansion needs its own compliance check.

Kaitlyn O'Connor:
Having a fragmented state strategy can get you into the same sort of boat where not every state says the same thing. So if you're based in Arizona and you understand Arizona law really well and how it applies to you, and in Arizona, what you're doing is not going to implicate Corporate Practice of Medicine rules, that doesn't mean it won't implicate corporate practice prohibitions in California.

So if you're going to California next and you don't look at the California law and build a model around that, you can end up in a situation where, yeah, what you're doing in Arizona is fine, but what you're doing in California is not.

Chris Madden:
And if you ever doubt how much this all matters, just ask the seller in Kaitlyn's story. They lost millions off their sale price because of compliance gaps. One oversight can become a seven-figure problem.

That's the real-world cost of not knowing the rules.

Kaitlyn O'Connor:
I was working for a private equity firm. I was doing some diligence on a $50 million acquisition. And in the process of doing my diligence, which was very specific to Corporate Practice of Medicine, I identified that the corporate structure of the telehealth company that this private equity firm was acquiring was not compliant in like half of the states where they were operating.

And my clients reduced their purchase price by about 10%. So that was a big hit to the seller, who had expected a $50 million acquisition, and they ended up selling for $40 million because they had to put a bunch of money in escrow to pay lawyers to redo their whole corporate structure after that deal closed.

And there was more risk than the buyer initially anticipated. And so they said, we're going to hold back some money because of these types of things that can have real-world, very big impacts on both your business and your patients. And it's just important to understand where those pitfalls are and how to navigate them at the initial stage and on an ongoing basis so that you avoid these kinds of things when you're selling or getting investigated by the government.

Chris Madden:
The laws don't change that much, but technology and the companies seem to change quickly. I asked Kaitlyn where she saw all of this going, whether it's creative approaches to apply existing laws, or if she saw new laws coming in the regulatory environment.

Kaitlyn O'Connor:
So I hope that they change. I hope that we see Congress finally, for example, make permanent changes to Medicare telehealth reimbursement. That is a slow process, and there are always other priorities that other stakeholders, for example, large tech companies are focused on and can afford to lobby really heavily for Congress to focus on.

So I do think that we will see some regulations change in the coming years. I think the biggest area where we are definitely going to see evolution around laws and regulations is going to be in federal and state privacy laws. There's already a proposed change to HIPAA out there. There are a bunch of states that are creating their own privacy laws.

And then I also think that we will see a lot of evolution in the regulatory landscape governing AI. We know that AI is valuable. We know that it can add a lot of value in healthcare, both on the operational side of things, making providers' lives easier, as well as on the treatment side of things, making patients healthier and helping them access care and stay more engaged in their treatment than they would otherwise be.

But nobody really knows how to regulate that yet, and to state governments' credit, for example, they're thinking about the fact that technology changes so quickly and how do they build legislation that will be more evergreen so that it doesn't get outpaced by the technology so quickly that it becomes prohibitive to innovation.

I think we'll see a lot of new regulation around AI, and I think we will hopefully see some permanent changes to federal reimbursement for telehealth, which seems old and necessary, but it just takes time to make those changes.

Chris Madden:
When marketing and legal teams work together instead of against each other, growth doesn't have to come at the expense of compliance.

The most successful digital health companies are the ones that bring their legal partners into the conversation early, not as roadblocks, but as creative allies.

As we've heard today, staying compliant doesn't mean slowing down. It means building smarter, stronger foundations that let you innovate with confidence.

With the legal guardrails in place, we turn to the future. Our next episode, episode 18, explores AI's impact on health marketing, how predictive models and personalization are changing the game.

Chris Madden:
Digital health is complicated enough. Add in regulations, federal, state, and even local, along with different insurance networks in different states, and suddenly growth feels like a maze. So how do you craft acquisition strategies that scale across fragmented US markets? This is Marketing Digital Health, and I'm your host, Chris Madden.

Today we're focusing on state by state rollouts. We've gained insights from Ankit Gupta, Jessica Holton, and Returning Voices, Rebecca Gwilt and Joanna Strober. They've driven state by state growth and digital health, and they've discovered strategies to combat so many varying regulations while scaling their companies.

Rebecca Gwilt breaks down why state by state rules exist, how licensing boards hold on tight to their authority and why navigating HIPAA insurance and state regulations creates so much friction for digital health companies. Rebecca Gwilt is a healthcare regulatory attorney and co-founder of Elevator Law.

We introduced Rebecca in episode 15 around privacy and compliance in marketing.

Rebecca Gwilt:
So when you think about the complexity in healthcare related to state by state regulation, in addition to the layer of federal regulation, that sort of covers a lot of government sponsored healthcare. And then of course, HIPAA is the big federal law that applies regardless of whether there's government insurance.

There are layers upon layers. So there are state medical boards and other state licensing boards. Behavioral health boards, pharmacy boards, dental boards, they have a job to do and they have funds to collect. They are state agencies by and large, and their job is to take care of the citizens in their state and to take care of the profession in their state.

And so they have a vested interest in having control over that and don't wanna give it up. To anybody else. We have seen a lot of pacts between the states, licensing pacts, telemedicine pacts, but we haven't seen a real effort or desire on the part of a lot of states to give up that kind of power in service to an easier experience for patients as they become mobile and travel all across the country.

And for doctors that wanna become mobile and travel across the country, there are very important reasons why states are in charge of these things, right? They have the ability to audit, they have the ability to investigate. They have the ability to react to local needs in the way that the federal government can't react to local needs.

And frankly, just the inertia of having done it this way forever means everybody has a job. It's important to them that is funded by the state that they wanna do a good job at, and they don't want someone else coming in and usurping that authority.

The insurance landscape, while insurance companies are regulated on a state by state basis, insurance is mostly governed by contract and because of consolidation, there are very few relative to what there used to be insurance companies around, and they have the ability to choose their region.

A lot of insurance is regulation when it comes to what applies to the insurance companies themselves. When it comes to providers contracting with insurance companies. That's a creature of contract. That's why providers can get national payer contracts, but payers can't be regulated nationally. They're regulated in their individual states.

Chris Madden:
Next up, Jessica Holton digs into how privacy laws are evolving. Jessica Holton is the co-founder of ours Privacy, a HIPAA compliant customer data platform, and third party pixel replacement for healthcare marketers. Ours privacy acts as a privacy first buffer, removing PHI from data flows while still enabling ad and analytics optimization across the funnel. And it also provides consent management, giving organizations control over how user data is collected, stored and shared.

Jessica and team work with leading digital telehealth companies, hospital and health systems and wellness brands to make privacy infrastructure both compliant and growth ready, California, Washington. And now more than 20 other states are rolling out new frameworks. Jessica explains how companies have to build flexible consent systems that adapt in real time. Because nothing about these regulations stays static.

Jessica Holton:
From our view, the US is moving beyond a HIPAA centric approach that applies to all healthcare companies in the US to a fragmented state driven infrastructure or state driven approach. And one of the perceptions is that HIPAA takes a long time to get up to speed with all of the digital ways of doing marketing and digital ways of processing health information.

And so states have taken up it upon themselves to implement new privacy framework. The two states that we see come up quite a bit is California and Washington. California with CCPA and Washington with my health, my data.

So CCPA, it expands consumers' rights to opt into consent and to opt out of data sharing. So it requires that any company doing business in California at a certain scale must let California users opt out of having their behavior shared with third parties, and they must be able to have that opt in withdrawn if needed.

So it actually goes beyond healthcare and it applies to any business, but for healthcare companies, it means that you are not only following hipaa, but you're also following this state privacy law. And then Washington's my health. My data also goes beyond hipaa, and it covers consumer health data, even when it's not tied to a covered entity.

So this expands the number of companies that need to take a privacy oriented approach when it comes to tracking and then sharing that data with third parties. So for example, for my health, my data, let's say a mental health app collects search behavior or geolocation related to going to a clinic or searching for a clinic.

It might not be, if that app is not under hipaa, it still might be regulated under my health, my data, and that act also requires prior opt-in consents before collecting data and separate consents, before sharing it with third parties.

And so what we're seeing is several years ago there were less than a handful of state privacy laws, and now they're over 20 and they're just increasing. And so there's a world where we ultimately have 50 different configurations that you need to follow state privacy laws and for an organization that is marketing to consumers or marketing to patients who are across the nation or across many states in one particular region.

You need to keep up with that. Not only are the state privacy laws that are coming out and being established increasing, more states are coming out with their privacy laws every single month, but they're also updated. So not only do you need to contend with the states that have different privacy laws, and you need to follow those, of course, but you also need to keep up to date with the changes that happen with the estate privacy laws.

So you can't, hard code rules you. They vary by state and ends. They change often. And so the way that you do consent management, you have to take into account the states and be able to, based on the location that user is viewing any information on your website or interacting with any of your domains or properties.

You need to be able to adapt legal language dynamically and log consent per jurisdiction. And you also need to future proof that and build dynamic rules that let you change that configuration and do so in near real time. Because as things are changing, as laws are changing, you have to be able to have a system set up that you can modify to continue to comply with those laws.

Chris Madden:
Jessica's point sets the stage for founders. If you're trying to grow quickly, compliance can feel like an anchor, but the reality is, if you don't stay on top of it, you risk losing customer trust or your entire business.

The stakes are that high, and this potential tension between performance and compliance is one that every founder has to contend with.

Jessica Holton:
It's really, really hard because founders want to, of course, grow quickly. And of course, they don't wanna put their business at risk or do anything that puts the trust that they have with their customers at risk.

What we've seen is across the entire spectrum, we've seen on one hand founders who either don't want to take on the risk of these ever-changing and increasing laws, and so they just stopped tracking entirely. And they take the risk off of their plate and they stop tracking. They do, instead of targeted performance marketing, they do brand campaigns that they do not have to share back data to Facebook, Google, et cetera with.

And they feel comfortable with that because they know that they're not tracking, they're not doing anything that they could get in trouble with.

Now, I will say it's very, very difficult to eliminate risk. Because you have likely, a lot of scripts, people have a lot of different scripts on their site that you don't actually even know is by default transferring data back to Google, let's say. So this is an aside, but things like maps or videos that are hosted by Google end up sending that data back to Google.

And there are a lot of kind of areas that you might think or not even consider as being something that is being tracked and shared back. And so it is very difficult for a founder to say and do the elimination of risk entirely.

And then on the other side of the spectrum, we have founders and marketing teams that work very closely with their legal teams to understand what every single state privacy law is and how it relates to them. And then they work with a consent management platform to enact that on their site.

And so they are using different legal language on the cookie consent banner that pops up based on the state. And they are updating that in real time in partnership with their legal team to make sure that they continue to comply and they're working with a consent management platform and they're reviewing it consistently.

And of course on that side, the benefit there is that is twofold. One, they are honoring privacy of their customers and they're showing their users on their site. Transparently, what they're tracking and what it's being used for, allowing users to withdraw consents. And two, once they have consents, they're able to track and share back some data, select data that ideally they still have control over before it goes on to Facebook, Google, third parties.

So the reality is often companies are somewhere in between where they tend to set up the infrastructure, let's say at one point in time. And then let it sit as such, and that should work as long as it's set up properly. The problem is these laws are dynamic and increasing what seems like every day. It's not really the kind of thing that you can just let sit and persist forever because you need to make sure that you're on top of that.

And so it's really important to be able to have a system that can grow and modify with you. And that you can continue to work with your legal team, but make changes as needed without having to undo the whole configuration. So what we always say is work with a consent management platform that is built specifically for state privacy laws and for healthcare, because you don't wanna have to undo workarounds that you put into place to get initially compliant when those laws are definitely going to change.

And so that's why we built the consent management platform is we are built specifically for healthcare and specifically for geo-located consent management, and we make it extraordinarily simple and straightforward to make changes to your configuration as laws evolve and as your business needs and compliance needs evolve as well.

Chris Madden:
Un Gupta is the co-founder and CEO of bicycle health. A leading virtual care provider for opioid use disorder treatment with a background in engineering product and mission-driven entrepreneurship. Ankit built bicycle to address one of the most urgent and complex public health challenges in America.

His perspective sits at the intersection of access, growth, and care delivery with a strong belief in technology's ability to scale compassion and measurable health outcomes. T's story of building bicycle health. Shows that when you're helping to solve a critical and widespread health crisis, scaling across states is a necessary and intentional process, one that is taken step by step.

Ankit Gupta:
We should not exist if everything goes well, but there's such a large access gap. 90% of people with addiction don't have access to treatment, and even if there is frequent access, you have to reach the person at the exact right time when they're ready to make a change in their life.

And so it is really hard to reach patients, and it is really hard to sustain a business in this environment with a lot of the regulation. Thankfully, I didn't know any of that when I started working on bicycles. I was really naive. We're in California, we're really helping a lot of people, and if people just hire more providers, then we could see even more patients.

In order to hire more providers, I need some funding and I was able to raise a seed round. Thankfully very quickly because of some of the relationship I had signify investor medicine, well has been a fantastic partner since then. And so we got the money in the bank. We were able to start hiring more providers.

We were able to hire a software agent to actually make a website and actually, you know, put, it was just like one key that, another for what the ultimate mission is that we need to do, which is reach more patients along the way, we learned all the hoop that we have to jump through and so.

There are some really big learnings around regulatory challenges that we have to overcome. I always had a heart attack every time we had a legal bill that I had to take 'cause it was just so many federal, state, local regulations that we had to fully understand before we could even start doing business in, in, in a state.

And expanding from one state to the entire country had to be a very sort of intentional step, step success. Where we had to really understand the regulatory landscape, understand the reimbursement landscape, be able to match the patient acquisition with the hiring of the providers. And essentially put together a roadmap for which state we're gonna launch at Bitcoin, and then continued Etrade on that roadmap as we learn more and as we opting, it

Chris Madden:
It sounds like a national ad would be so much easier.

Right. Joanna Strober is the founder and CEO of MIDI Health. We introduced Joanna and. Episode one around why marketing digital health matters. She explains why so many digital health companies go state by state rather than launching nationally. It's expensive, it's operationally difficult, and it requires balancing supply and demand across every state and every region.

Joanna Strober:
Digital health is hard. Operationally. Digital health is actually really hard, and particularly when you add insurance coverage to the mix. But even without insurance coverage, people have to be licensed in each state in order to provide care. So you hire nurse practitioners and maybe they have one or doctors, and maybe they have one license in one state, or maybe they have five licenses, or sometimes you get lucky and they have 10.

But they can only offer care in those states. And what you don't wanna do as a digital health company is hire a bunch of people who are not busy in a state because you can't afford to do that. And then also when you add insurance coverage, you need to get them enrolled in each of the insurance companies.

When you combine all that together, it's very hard to roll out nationally because then you have a lot of people who might be sitting around doing nothing. So that's why we end up doing state by state instead of national. It's just too expensive to do national. A number of companies have essentially gone outta business because they tell employers that they're gonna be a national company and then they hire all these people and they're not busy.

That's very damaging for a company, but we also know that once we are national ads are much cheaper. What we found is one of the reasons why we needed to have national coverage is that it's much cheaper to do a national ad campaign than local ad campaigns. So we've had to balance that. We do have a lot more supply in some states than others, so we have to balance for our marketing how we do those two things.

Chris Madden:
Joanna's strategy is rolling out state by state. This is a common strategy across digital health.

Joanna Strober:
That's exactly what we do. Start in one state. You get insurance coverage in that state. Then you went to, we started in California and then we went to Texas, and then we slowly hired NPS and got them.

Licensed in different states and then got them credentialed with the insurance companies in different states. So it's just, it's a very expensive, time consuming operational process

Chris Madden:
For Ankit at bicycle. The state by state rollout was not instant. It was years and years of going a few states at a time. His team made smart use of compacts and local rules accelerating where they could.

Ankit Gupta:
So we first decided to launch in states with a purely self-pay model. So we didn't want to wait for instrument contracts because there's a certain segment of the population that is still willing to engage in a self-pay model because of the lack of access and the demand be so high.

And so that removed a big across. But even to have access for software patients, we needed providers who have appropriate licenses in those states. We needed to check off all the boxes from a regulatory compliance standpoint, and so we put together a roadmap. I believe in the first year we launched five or six states and year we launched under 10 or so state.

It was a slow and steady progress, maybe one or two states every month where we needed to. It was almost like a checklist of like 30 or 40 thing add me to do. For every state launch ad and there were not a lot of people working at that kind. So few of us working ly I remember, was responsible for hiring providers.

I had someone on my team responsible for getting them licensed in the state that we have to be licensed in. Our chief medical officer was responsible for onboarding them and making sure we underst technology. There were some. Ways in you could, in which we could optimize this. For example, there are interstate medical licensure compacts, and so if the physician had a license in one state, you could more easily in the other state, or there are some states where you don't need a physician supervisor and nurse NPS can independently practice medicine.

And so we relaunched in some of those states ahead of the states where you needed MD supervisors understanding the regulatory landscape and figuring out. What is the shortest path to pro, having capacity in the state and did that. One of the other things that we couldn't fully understand at that time is what is the demand look like?

Like if we launch in Arizona, how many patients will we actually get versus launching? In Colorado, we intentionally didn't use public data to plan on national extension because public data is highly biased towards. The overdose death rates and the opioid prescribing rates. And intuitively we felt like there was a lot of undiagnosed opioid use disorder and patients just not raising their hands, asking for treatment.

And if we start having capacity in that state, like if you build, they will come and a pain, which is never a something you should do. Right. But in this case, we, but like if we had capacity in that state and the market in that state, we might. Have a totally different demand profile than what our data shows us.

So we intentionally didn't worry about demand. We made sure we created the supply, and we basically try to create a supply for as many people as quickly as we can based on the state regulations and the hiring that we do. So that's how we created like a National Day model, and then we started getting insurance contracts on top of that.

Chris Madden:
This is such a good example of discipline scaling, knowing you don't need the whole country on day one. Just the right states, the right licenses, and a team willing to chip away until a national footprint becomes real. Jessica reminds us of the big picture. Regulations will keep changing. Policies will shift.

Platforms will update. The only way to stay ahead is to build systems that adapt as fast as the rules do.

Jessica Holton:
I'd also just say as things change and as platforms change their policies and as state privacy laws change and evolve and come online, the facts that you have a system in place that can be easily modifiable.

As things come up means that you'll ultimately avoid costly disruptions because you don't have to go back and undo the hard-coded workarounds that you might have had in place at some point. So having that modifiable system that adapts with you is really important.

Chris Madden:
Here's the takeaway. Growing a digital health company across all states in the US isn't just about speed, it's about resilience.

Success comes from patients pushing where appropriate adaptability. And a willingness to treat compliance as a part of your growth strategy, not an obstacle to it. Legal and marketing don't have to be at odds. Our next episode, episode 17, shows how collaboration between the two can unlock not just speed and safety, but also strategy.

Chris Madden:
Patient privacy isn't just important. It's the foundation of trust, but here's the challenge. How do you navigate hipaa? P-H-I-H-H-S? And the alphabet soup of regulations and still market effectively. This is Marketing Digital Health, and I'm your host, Chris Madden. We've got some great voices back with us, Adam Putterman and Marina Alves, plus a new one.

We're introducing Rebecca Gwilt. Rebecca Gwilt is a healthcare regulatory attorney and the co-founder of Elevator Law, where she helps digital health companies design legally sound, market ready business strategies. With deep expertise in HIPAA data governance and the fine line between innovation and compliance, Rebecca is a trusted advisor to founders, marketers, and legal teams navigating an increasingly high risk environment.

Together, they'll help us unpack how to stay compliant, avoid legal landmines, and still connect with patients in meaningful ways. Rebecca starts with how the legal landscape around digital marketing has changed in the last few years, listing some key changes, what worked, and some unknowns that threw companies for a loop.

Rebecca Gwilt:
So the last five years, I would say, have been a really interesting time in the digital health space. We had a wave of people sort of come out of the woodwork during COVID, who all of a sudden started paying attention to what worked and what didn't in the healthcare sector, and many of them wanted to fix it.

And we were at a point in our history where we all realized that the old way of delivering care may not be the best way of delivering care. And so lots of people jumped in and many of those people did not come from the healthcare sector. And the reality is that entrepreneurs that cross between industries often are the most disruptive and the most clever.

Mark Cuban is a great example. He all of a sudden had somebody that told him about PBMs and how prescription pricing worked, and he said, well, that doesn't make any sense. Let's do something different. And it really took somebody from outside the industry to come in and create a big disruption.

That said, during that time a lot of things were tested and tried, not only from an operational perspective, a technological perspective, but from a legal perspective. Models of companies and models of reimbursement that didn't exist before 2019 became huge. What comes to mind is the remote monitoring sector. It became a multi billion dollar industry overnight given these changes in CMS laws, which in many ways were ushered forth by the pandemic.

So now that we're mostly back to business as usual, what I'm seeing in the last couple of years is a lot of differentiation out of necessity and consolidation. In 2021, there were a bajillion telehealth companies that were doing basic urgent care, internal medicine for the industry. And today what I see is clients coming to me saying, I'm really passionate about pediatric occupational therapy for kids with multiple chronic conditions. I want to build a company around this.

And those companies are being built slower and more deliberately and more creatively. And so five years ago, there was a cookie cutter roadmap for the few of us out there, shout out to my telehealth colleagues that built these kinds of businesses, and it became in a way commoditized. I don't want to name names, but there's companies out there that are building the infrastructure for telehealth in a way that didn't exist before.

Now what we're seeing is founders that are saying, yeah, yeah, yeah, we get it, we know how you sort of do that, but we're thinking about a more creative business angle, or more creative financial angle, or more creative clinical angle. And for that reason, we've got to do things a little bit differently. So frankly, it's made my job a lot more interesting.

And I also think in terms of why I get up and do this every day, it's more fulfilling. I know exactly the kind of people that my clients are setting out to help. I know exactly how it's going to help, and that helps me as their lawyer sort of align to that and be creative in the way that I can be.

At the HIPAA level, you are looking at a subsection of healthcare data that the federal government is able to govern, and that is protected health information, PHI, that is used and disclosed by covered entities and business associates who are processing standard transactions. Important to note a couple of things.

Most people believe that if your doctor's office has your healthcare information, you are protected by hipaa, not the case. A lot of concierge practices that don't process insurance and cash pay practices, they are not subject to hipaa, but they are subject to the health breach notification rule.

Digital health companies that are cash pay companies that do telemedicine visits and collect lots of healthcare information about you, that you're using your credit card to pay for, your information is not protected by hipaa by those companies unless they have payer contracts, unless they're processing what we call standard transactions.

So there's a whole swath of healthcare information out there that's being collected, used, disclosed, sold by healthcare companies that HIPAA doesn't cover. And so OCR, which is the federal agency under HHS that enforces HIPAA, and the Federal Trade Commission that enforces Section five and enforces the health breach notification rule, got together and said, we're nervous about the public's information being bought and sold by companies because I don't think the public is aware that it's not being protected.

Now, I know this is the case because some of the companies in this space are not aware that this is the case. So the FTC stepped in, in 2023, to police health data misuse where HIPAA doesn't apply, and GoodRx, which is a prescription discount and telehealth app, was not a covered entity. On their website they said, we're HIPAA compliant, in public facing documents said, don't worry, we respect your privacy and we will never share your health information with others. And in their privacy policy that was published on their website, they said they protected the privacy information, didn't share it with others for any marketing purposes, et cetera.

Turns out all that was baloney.

Chris Madden:
Both companies ended up facing fines. GoodRx was fined 1.5 million dollars for sharing prescription drug discount and telehealth user data with ad platforms like Google and Facebook, despite promises of privacy. BetterHelp agreed to pay 7.8 million dollars under an FTC order, which also bans it from sharing sensitive mental health intake data, like email addresses and therapy history, with Facebook, Snapchat, et cetera, after promising privacy.

For BetterHelp, the FTC made it a point to say there was an untrained, inexperienced, young marketing person in charge of Facebook advertising and data uploads. BetterHelp promised not to share personal health data.

Rebecca Gwilt:
but secretly did share it, or inadvertently, or what have you. They sent it to Facebook, they sent it to Google, various sort of advertising and marketing analytics platforms got real information about real patients. And the FTC said that was a deceptive trade practice. You told people that you protected their data in accordance with industry standards. You told people you were HIPAA compliant. You told people in your privacy policy that this wasn't going to happen, and it did.

And so they got hit with the FTC’s first ever health breach notification rule enforcement action. They had to pay in the order of millions, and they had an order that's going to last for the next 20 years that makes them subject to scrutiny by the federal government for their practices. That was a warning sign to the industry that this rule that hadn't really been enforced ever was going to start being enforced.

The FTC and OCR together said, we're getting serious about the privacy and data protection issues related to consumers’ healthcare information, and we're now going to focus on it. In 2022, HHS published a bulletin, and the gist of the bulletin was even if a person is simply browsing around on your covered entity website, on your hospital website, you're collecting their IP address, they're on your website.

We believe it's reasonable to conclude that because you have an IP address, which is arguably identifying, and because they're on a healthcare website, which is indicative that they're interested at least in healthcare, that if you are sharing that information, if you're sharing the IP address of those folks using pixel tracking technologies and then uploading that information to a third party advertising company, that this is a HIPAA breach.

And the hospital association, the American Hospital Association, pushed back enormously. And HHS ended up revising that bulletin, but they still said, listen, just because they're on the website, maybe that doesn't mean that it's PHI, but if they're on the website looking for healthcare, then yes, it's PHI.

And again, the American Hospital Association said that is a gross overreach. How are we supposed to know the intentions of people who are surfing our website looking up diabetes information, and the American Hospital Association filed suit against HHS. They pushed back pretty hard. HHS ended up losing that case, and in the summer of 2024, the court out of Texas basically ruled that this narrow piece of this guidance, that said just the fact that someone is browsing around on your covered entity website and may be interested in healthcare, that doesn't mean it's PHI. That's an overreach that expects that the hospital knows the intent in the mind of the person as they're browsing, which obviously they could never know, and because they are not clairvoyant, that information, that IP mixed with just being on a healthcare website, isn't enough to call that information PHI.

What I saw is a lot of my clients and others in the industry saying, whew, that guidance is null and void. We don't have to worry about pixel tracking technologies anymore. The American Hospital Association won. Let's keep doing what we've been doing. And the reality is that narrow portion of that guidance has been rescinded, and you'll see it on the HHS website or on the OCR website, but the majority of that guidance stands, and this is where things get tricky.

The court said, regulations say in order for something to be PHI, it has to be individually identifiable health information, and that means that it has to have two key features. One, the information by itself has to be identifiable, and many courts have ruled that an IP address by itself with nothing more is not identifiable, but an IP address mixed with someone's name is identifiable.

So it has to be individually identifiable, and it has to have to do with the past, current, or future health or healthcare of that person or payment for healthcare related to that person. And so companies, when they're deciding what kind of information that they can pass back to third party platforms, need to make sure that information is either not having to do with healthcare or not identifiable.

If it is both and they are a covered entity, they have violated Hitler*. If it is both and HIPAA does not apply to them, there's a lot more flexibility. We can go through some best practices, but you've got to have some best practices together to make sure that you are not running afoul of the Section five law, you know, Section five against unfair and deceptive trade practices.

That means your privacy policy should be very clear about what you do and do not do with that information. Your website should be disclosing and not hiding how you're using patient information. And depending on the state you're in, there might be opt out or even opt in requirements for certain uses of information and types of information.

Chris Madden:
Marina Alves is our technical lead at Matchnode. We introduced Marina in episode seven during the overview of the paid acquisition funnel in digital health. After Rebecca has set the stage, we turn back to Marina Alves. Marina shares how marketers are responding to those privacy challenges in real time, specifically how data gets managed, what platforms will or won't allow, and why more teams are turning to customer data platforms or CDPs to keep control of what's shared.

Marina Alves:
Technically, we would have the freedom to send through all the data that we can and we have access to send. Most of the time, we are not allowed to for legal reasons, either that be a restriction from an ad platform or from the client's own legal team, who doesn't want us to share something with a pixel or have that kind of information on the website.

So the trend, I'd say, that I'm seeing is a lot of the health clients are maybe stepping away a little more from Google Tech Manager* and moving into using CDPs, which are Customer data platforms more, because in there you have more control over what you actually send through to obey the legal team's restrictions that they're putting on there.

Chris Madden:
Adam Putterman is the co-founder of ours Privacy. We first introduced Adam in episode ten when we discussed technical setup around events, signal resilience, and attribution. Adam dives deeper into CDPs. He explains why they've become essential for healthcare marketers who want to run performance campaigns without exposing sensitive data to platforms like Meta and Google.

Adam Putterman:
What happened a few years ago that really brought the CDP conversation to the forefront of many healthcare marketers' minds is that there was a large increase in FTC action, OCR action, and then civil class action lawsuits and media outreach or publication highlighting healthcare companies, particularly health systems and large mental health platforms, that were not only pixeling their marketing site and sending all of that data back to a Meta or Google, but were also in some cases putting a pixel on their backend platforms and sharing actual patient experience or user journey data.

So there's a ton that's wrong with that. And I think where the regulations and the guidance and really consumer sentiment and the market has landed is that if you sell a sensitive product or experience, a healthcare product in particular, and you're sharing back with a Meta or Google purchase data and identifying data of who made that purchase, or Adam Putterman went to this website and did these things and then bought a therapy session, and his email is this, and his IP address is this, and the type of therapy session he bought is this, that's health information.

What a lot of healthcare companies need to do very quickly is find a way to run performative advertising and effective analytics without sharing that data to platforms that wouldn't sign a BAA, or that were non compliant, and that's where CDPs came in, because instead of having to reinvent the wheel and build all of these integrations natively and essentially become an advertising company more than a healthcare company, what a CDP enabled these companies to do is to modify or remove user properties before they went back to platforms like Meta and Google.

Chris Madden:
Large hospital systems and some mental healthcare platforms used to encounter data privacy breaches, some data that clearly should not have been shared. CDPs like ours Privacy eliminate that problem when patients are being onboarded. The most advanced and current approach to data management and signal resilience, ours Privacy is HIPAA compliant and purpose built for digital health.

And to Adam, things are never black and white in the healthcare space. They're gray, it's a spectrum, it's dependent on the type of services you're providing and many other factors.

Adam Putterman:
In general, the consensus that we've seen develop, and you can see this by reading the HHS guidance, you can see this by reading some of the class action cases that have been made public in the last year, is that you need to be careful sharing the combination of identifying user data and a purchase or high intent or inferable action.

The metaphor we always like to use here is if you were to go to a store or a library and check out a book on mental health, and then as you walk out, the library called up their contacts at Meta and said, hey, Adam just checked out this book. By the way, he lives at this address, his email is this, his IP address, can you find me more people that want to check out these types of books?

That feels obviously wrong. That was kind of the state of things for a long time. And so we've seen a correction to that. And instead, what the library might do is say, hey, someone that you sent me did something I want more of. They might have checked out a book on mental health, but they might have just walked around the library for more than 30 seconds. And so what I'm going to tell you is just that of the hundred people that you sent to my library, 50 of them did something I want more of.

And that seems to be a much more balanced take on how to run effective yet privacy protecting ads and analytics.

Chris Madden:
Adam weighs in on the benefits of companies using a CDP versus alternative approaches.

Adam Putterman:
The compliance risk there is probably smaller than people expect. The real risk there is on the performance side and the resourcing side. So again, taking a step back on when a CDP makes sense or why you go with the CDP versus doing something internally, taking some other approach.

Ideally, what a CDP does is enables you to be compliant, of course. It also, of course, increases your performance. It reduces external media or legal risk because you're sending a signal to the market that you're taking extra privacy practices or investing in privacy practices, and then fourth, it decreases resourcing needs. You're not having to maintain it.

So enabling compliance is something I think companies can do internally, for sure. Increasing performance starts to drive a lot of the resourcing needs, because all of these APIs, like Meta's Conversion API and Google and Reddit, and the platforms start to add up. They're constantly changing and they require maintenance and upkeep and the best practices change.

And then you start to get into, well, how are you doing identity stitching across all these different touch points. Eventually, in some cases, if you're building something internally, you become a media company, not a healthcare company, and that's really what you're trying to not do.

So yeah, I think there are cases where it makes sense to do this internally. The main reason not to would be that it quickly becomes, or consumes, not just your marketing team but your engineering team, and that means they're not spending time on product, and your marketing team isn't spending time on strategy and creative and optimizations.

Chris Madden:
We broaden the lens again to include artificial intelligence. Rebecca covers the compliance risks that come with AI and why hospitals and health systems are suddenly adding strict new rules to their contracts.

Rebecca Gwilt:
So now they have entire summits all over the world, three to five days long, on healthcare AI. Top of mind for the moment in terms of what my digital health clients are asking me, a lot of it is in the context of what they need to do to get through procurement with very large healthcare buyers.

So as hospitals, health systems, employers, other very large healthcare entities, pharma, as they become more educated about the potential risks and the nature of the AI that could be used within their organization, their legal departments are beefing up their compliance measures, their contracts, their governance around this. AI has the ability to very quickly get very bad. It is one of these things where it goes bad and the scale of the bad could be enormous.

And these are entities that are in charge of very sensitive data about millions and millions of people, and they are going to err on the side of very stringent measures once they get their head around it. I would say a year ago, two out of five hospitals didn't even ask about it. This year, probably three to four out of five hospitals ask about it, and one out of five has really mature language in their contracts that either say, can't use it at all, which forces the conversation about what it is, what it's doing, what information it's collecting, how it's training its algorithm, whether it's using de identified or identified data.

What are the outputs, who owns the outputs, who owns the analyses, what are the IP implications. All those things are bubbling up in the procurement process now in the digital health space. And what I tell my clients about is they better have answers to these questions, or what was already a hard process, a six to twelve month procurement process, is either going to be scrapped because you can't get past their AI governance board, or it's going to be extremely long and that's going to put your company in jeopardy, especially for early stage companies.

Chris Madden:
I was curious about how working in digital health and dealing with privacy concerns has affected Adam and his own health journey. Even as a patient, it's easy to sign forms without realizing what you're agreeing to. His experience shows just how much fine print can slip past us.

Adam Putterman:
Yeah. I need glasses and, and the other day I went to get my eye exam so that I could get glasses, and I was checking in, and after I signed in, they're like, okay, now we need you to sign a few forms. And then they just turned the signature block around and asked me to sign.

I asked, what am I signing, and they're like, oh, it's a HIPAA authorization. Then of course my ears perked up, because I'm like, oh, I wonder what it is. But they wouldn't show me what it was, they were just asking me to sign it, which, now I'm probably the worst customer or patient from that perspective. I want to know exactly what I'm authorizing and what I'm giving consent to.

So I asked them to show me, and they couldn't show me on the screen, so they had to print it out. And then I reviewed it before signing, and it ended up being interesting, because among many things I was potentially unknowingly consenting to, one was publishing the scans of my eye with, I think, identifying information in any journal, which felt like something I definitely didn't want to do.

I still signed it because I needed the eye exam and I didn't want to go somewhere else. But I think the number one way that it's affected my health is that I've become a pretty terrible patient from that perspective, which probably doesn't help me get great healthcare, but I'm just so much more, I just want to know. There's no problem I'm needing or wanting to use my eye scan to publish in publications, but I would prefer to be asked about it.

Chris Madden:
Here's what I hope you take away. Protect patient trust like it's your most valuable asset, because it is. Stay curious, stay compliant, and don't treat privacy as a barrier. Done right, it's actually a competitive advantage.

Compliance gets even more complicated when every state in the US can have its own rules. Episode 16, our next episode, examines how to navigate state level fragmentation without losing momentum.

Chris Madden:
One of the most powerful and misunderstood growth models in digital health is B2B two C. It is where employers, payers, and providers meet your patients. Get it right, and you can unlock massive reach and increase trust. Get it wrong, and all those contracts and partnerships just sit there doing nothing.

This is Marketing Digital Health, and I'm your host, Chris Madden. Chris Turitzin and Nate Purpura are back to guide us through it. Chris Turitzin is a growth advisor for digital health companies and is the founder of Single Aim Marketing. We introduced Chris in episode one around why marketing digital health matters.

He starts with referrals, a strategy that feels old school but still delivers. The trick is making it real and local. He talks about companies building real relationships with referring providers, not just sending a few emails and hoping for the best. I love that he highlights the difference between a referral strategy that is just an idea and one that is an actual operational motion with boots on the ground, local credibility, and data to prove that it is working.

Chris Turitzin:
You will see a company like a D two C company saying, we want to do referrals. And then they will get a few doctors to send them patients. The doctors will maybe trickle a few in, but they cannot scale it up and, or those doctors will eventually forget about them three or four months later.

The thing that is true about our referral based approach is that it is a very real endeavor and it requires a very real on the ground local relationships approach, which some may compare to like a pharma sales model, but the reason it works for local businesses is that they are literally down the street. They are in the community. It is a very tangible thing for a doctor referring to send people to.

So there are some examples. There is a company I love referencing called Ideal Option, which is in the substance use space. The reason I love it is that they publish a report every year of their referral volume and how they are doing it. So there are these yearly reports. I think they are getting like seven to ten thousand referrals a year, something along those lines, and they talk about how many people they have in the world and how many essentially bases they have around the country.

So it is just a different approach, but it is a real investment they are making to do that. I think one approach that I also want to say, we are talking about referrals, is so, either you have this local approach, or in certain cases, your treatments are so high volume and so high need that you can make more of a sort of top down referral model work.

For example, during the pandemic there was such demand for therapy that companies like Headway were able to make referral partnerships with these large health systems and they would just stream people their way. A company like Brave Health does Medicaid mental health. Again, exceedingly high demand, and they are just like flooding in referrals.

But the reason that works is it is both high volume in the sense that they offer a fairly generic product like mental health services, something that comes up in a physician or a referral coordinator’s life like every hour, every day, and very undersupplied by other options. If you have those two things, then you can make a top down telemedicine referral thing work.

Otherwise, I think a lot of people think that they are those two things. It is just not strong enough in those, so the referral thing, referral thing from a telemedicine perspective, fizzles.

Chris Madden:
Then Chris walks us through the three big growth models in digital health. You have got direct to consumer, where you are fighting for every click and conversion. You have got covered populations, the B2B two C world where employers or payers unlock access to your audience. And then there is the referral based growth, which looks a lot more like traditional healthcare.

I love how he makes this framework feel simple and actionable because too many companies try to do all three at once and end up doing none of them well.

Chris Turitzin:
Often people talk about digital health or virtual care, and everything gets bucketed together into the same bucket, even though I think there are businesses that mechanistically are very different from each other. And if you just look at the staffing of those companies, they look drastically different.

So I would bucket these generally into three groups. One is direct to consumer. And to be clear, when I say direct to consumer, I am not saying cash pay, because that is often, in my opinion, a misinterpretation. Direct to consumer is just applying to the literal meaning of direct to consumer. It is marketing direct to consumers.

So these would be companies that essentially advertise online. Think of any of these weight loss companies, or women’s health companies, or men’s health companies, or the things that you would see on a TV ad, or the things you see when you search on Google, or you would see on Instagram or TikTok, a lot of mental health companies too. So that is direct to consumer, and if you talk to those companies, probably ninety ish percent of their incoming patients are coming from some direct to consumer channel.

The second category I like calling covered populations, or sometimes it is referred to as B2B two C. These are companies where you have to unlock a population before you can market to them. So usually what that means is an employer or a health plan starts paying for your thing.

So these kinds of companies offer treatment experiences that are slightly abnormal, so they do not fit into either a cash pay basis or into an insurance pay basis, like traditional insurance. They have a new model. Companies like Omada, Virta, a lot of these employer based mental health companies like Lira and Spring. Advantages of offering slightly less traditional services are actually big advantages in the sense that you can be more flexible in the actual treatments, but you need to basically get payment permission from an employer or a health plan, and then you need to get marketing permission from that employer or health plan.

So that is the second category.

The third category is actually the category that looks the most like traditional healthcare, and interestingly, I think it is the one that people think about the least in the digital health world, and that is basically a referral based business.

If you talk to most doctors, most of their patients are coming from referrals, just like traditional, like some ophthalmologist down the street or urologist down the street. They have a local network of physicians that refer into them, and that is how healthcare works. And it is also possible on more of a scaled basis, and there are some examples of it.

I would also say though, building a company like that is very different than building a direct to consumer company, and I think many organizations try to do everything and just do not succeed. So there are examples of referral based organizations. I know some in the addiction business. But yeah, those are the three different models.

Chris Madden:
One of the most fascinating parts of this conversation was when Chris talked about trade offs in the B2B two C model. On paper, it looks like free marketing. You have got access to a defined audience, employees and plan members that already trust their health plan or their employer.

But if you do not negotiate the right permissions up front, like being able to send SMS or direct mail, all that potential reach just evaporates. I have seen companies make that mistake. They win the contract, but do not get access to the audience.

Chris Turitzin:
It is a great position, but it is also a frustrating position. It is great in the sense that most of your marketing is essentially free. There are costs, for example, with mailers and sending SMSs, but you basically have been given permission in most cases to have free advertising to this population that is an employer base or is a healthcare base.

The biggest lever, from my experience in working with those organizations, is getting that access. It is a really common pitfall that you get some employer, “Yeah, yeah, yeah, we have got a hundred thousand employees,” but then somehow in the contracting you forgot to ask for the ability to SMS them or the ability to send mail to them, and then you get no enrollments.

After that, the kind of direct to consumer channel application to a B2B two C model. There is this point in time where if you are doing it really, really well, a B2B two C becomes basically D two C, because your product is so well adopted that you can run broad based marketing and have a pretty good assumption that enough of the population will be eligible for it, that you can market in that way.

That is a pretty long way down the road, and honestly, I am not sure if any of the larger digital health companies have gotten there, maybe in certain geographies.

Because otherwise, if you do that, if you just run ads on Google or run ads on Facebook, it is going to be too expensive, because every nine out of ten people will not be eligible for your thing. So you will be burning through money and the systems do not have any good way of targeting people that would be eligible for your thing.

A lot of those companies generally feel pretty frustrated by the paid channels. Maybe there is some nominal spend. Maybe they found some way of targeting like a small geo or some signal on the platform. SEO is a channel though that I think a lot of them do invest in.

Chris Madden:
That is where Nathan comes in. His background in journalism and PR gives him a storytelling lens, and he applies that to healthcare marketing in such a powerful way. Nathan Purpura, who we first introduced in episode thirteen around partnerships for growth. Nate is the VP of Marketing at Credo Health. To Nate, it is not about choosing one channel, it is about orchestrating them all so that the message actually lands.

I started out where my career actually in journalism. Worked in TV news as a producer and field reporting and anchoring and wrote print publications.

Nate Purpura:
And then eventually made my way to public relations and did a number of different kinds of corporate PR, and that started through force. Got my way into content marketing when that was not really a thing, but you just saw the shrinking pool of journalists out there and how much help they needed in pulling stories together, pulling content together.

I did more and more of that, sort of in my later stage of my career in public relations, really packaging, building content and data to support media on stories. And then when we started to publish those things, instead of us driving search traffic on Google for SEO, it was not as much of a specialized practice like it is now, but we would publish content. We would publish reports, obviously share them with select journalists first, and then we would publish them.

We noticed that the online traffic we got off of publishing content had more long term value in terms of lead generation through publishing our own owned content. And so I fell into content marketing that way. And then that sort of led into organic social media and then obviously how I ended up working at Matchnode, and then ended up running a partnership, a business to business to consumer channel in a public company called eHealth and figured out how to drive leads through strategic partners.

And then over the last five years went back to startups again, and all those skills have come in handy. So everything from SEO and organic social to paid media and, and certainly being in healthcare has become really important in the last couple of years.

Chris Madden:
Nate’s playbook is all about iteration. Test a campaign, collect the data, optimize, and repeat. I have seen this pattern in great marketing teams everywhere. They do not just set it and forget it. They learn, document, and build a smarter approach over time.

Nate’s point about having a playbook and not just a collection of assets really hits home. That is what separates average partnerships from high performing ones.

Nate Purpura:
You can work through providers, so you can work through the medical groups, through the health systems, and you can actually educate the clinicians. That is often very difficult to do. You can do some things to educate their care staff, and you can do great traditional marcom stuff where you are building assets and you are getting them placed in the medical offices. That is a tactic that you can deploy.

I have seen that work really well, and I have seen that crash and burn. Most health systems and employer groups will deploy a combination of webinars, text messages, emails, and direct mail. So you are really building what I call plays. You are trying to build an arsenal of assets where you can plug into their program whatever they are willing to run to do member acquisition for you.

And then where it gets really effective is if you tune it. Learn from those programs that are deployed and optimize your approach. And so when you enter a partnership, you go from saying, “What are you willing to do? Email, text message, call?” to saying, “Hey, this is the approach. We deploy this form, we run our program this way, these are the kinds of responses that we get.” That is the play that you want to get to.

And so that is the first thing. So there is not really one solution. That really depends on the program and partner, but ideally you come in with a playbook and a recommendation on approach that you have tested and learned on before, based on the product that you are in or the type of patient that you are going after, and then you optimize that over time.

So the first thing. What is really interesting now from an AI perspective, these tools that will help payers, help point solutions and digital health startups. They will use AI to segment member data. Whatever data they can get their hands on, they will do data analytics work and they will come back to you with segments and recommended messaging and recommended channels.

And so I think that is where this is going. In member outreach, like you said, one text message and ninety percent of people sign up, that is great. And so that is where all this machine learning will really help out. Typically, when you are starting out, your patient populations are often very small, and you are reaching out to a small group of people so that there can sometimes be ghosts in the data.

It takes time and repetition, and you have to be very detailed in the data that you collect and the way you deploy your campaigns. I find early on you do better when you partner with just skilled agencies, skilled external people that understand the program and how to build it, and then they can bring the right resources to bear to get you a good foundation in place. Once you have that foundation in place, then you start to really build an internal team to run and pull the right levers.

Chris Madden:
Then Nate brings AI into the conversation. We have talked about AI a lot in this series, but here is what is fresh. He is using it for segmentation and personalization at scale. He explains how machine learning can help match messages to member subgroups. That is not just by demographics, but by behavior, condition, and even communication preference.

It is a smarter and more respectful way to reach people.

Nate Purpura:
The areas that I have seen that I think are really interesting are segmentation. It is the ability to build cohorts of people based on everything from disease severity, to how severe are they and how much can you really help them, how much can your treatment program help them.

This is all data work that the team can do, but often the AI tools are just much faster, help you really understand what your attainable market is within a population. But then the other thing is who responds, and I think that is a smaller opportunity for smaller startups because you do need to track everything.

But payers are using this kind of technology to figure out, okay, this is my text message population. These people, there is a certain patient relationship that, say, they are moving a lot, they are changing jobs a lot. A channel like text might be the only way that they really receive it. They may not have an email address and read their email. Sending them a postcard or a letter if they are moving every six months or whatever is just not a good option.

Figuring out and carving out those different groups and how to activate different sub segments. Typically that is most effective when a payer, a health insurer, or a health system is using those things. They just know how to get to these different populations, and then you come in with the right content and the right messaging, and you may have recommendations on tactics or you may even have the tactics pre built, but they will say, “We are going to take direct mail and deploy that against this group. We are going to take text messaging and deploy that against Medicaid.”

The interesting things happening in AI are in those areas. There are interesting companies doing work there.

Chris Madden:
Nate also gets real about the challenges of direct to consumer versus B2B two C. In direct to consumer, in the case of cash pay, if you are asking people to pay out of pocket, that is a hard sell. In B2B two C, you are showing them a covered benefit, and that difference changes everything about how you message, convert, and measure success.

Nate Purpura:
The biggest challenge I have seen in direct to consumer marketing in healthcare, it is one area where people are not usually willing to come out of pocket. Healthcare is so expensive and most of us have health insurance. Technically everybody has access to it with Obamacare, Medicare, Medicaid, or insurance from your employer. You are paying monthly, seventy bucks, and then you have got a copay, you have got to come out of pocket for the full cost.

It is very, very hard to do that. I think the Hims and Hers of the world, those companies that go out and offer things, stuff for balding and sexual health, we know people will typically pay out of pocket for stuff like that. There the threshold, and you are going after an income bracket where most of the population is not very wealthy and does not have a lot of good disposable income.

So if you are marketing a healthcare service and it is not covered by their health benefits, price becomes a really big factor and you have to be very targeted with your offers, and you are doing a lot on digital channels to try and manage acquisition, because they are going to leave and come back and you are really trying to drive a conversion with every click very often. And it is very difficult to cookie and optimize your programs when you are in direct to consumer, and it is healthcare, and you have to protect their privacy.

Where B2B two C is very, very different. Typically in that case you are offering a benefit that is covered by their insurance. There is a lower barrier there to get them to consider it. You can create more personalized experiences that you do not have to cookie, and you do not have to do all the digital tracking and things like that that you really need to optimize a direct to consumer campaign.

In direct to consumer you want to be hashing data on the back end and you want to be building lead forms on Meta and Google so that you do not have to have it on your website. I mean, there is tactically so much in direct to consumer that you have to do that you do not have to do as much of in B2B two C, because you have just got a tighter, smaller population and you are doing direct response. It is easier to convert there and conversion is usually much higher because again, it is typically paid for by their insurance.

Chris Madden:
Healthcare is very personal. Working with digital health every day, I asked Nate how it has impacted his own life and health.

Nate Purpura:
It is interesting to be in this space because you get turned on to different treatment options that are out there, and you can understand where some of the inefficiencies in the healthcare system are. How often, if you just do not ask a question or you are just not talking to the right person, there may be a benefit or a treatment option out there that would be great for you. You just have not heard of it.

And I think in some ways it is frustrating and discouraging, because you are like, man, if we could just get this solution to the right people, we can really solve some big cultural issues. So that is interesting and does sort of encourage me and my family to look into some things like this.

So I know I have a daughter that has got a chronic skin issue, and I became aware of some virtual treatment programs out there that are really great, and we got plugged into those. To me that is much better than some of these prescription medications that are frankly really scary, immunosuppressants that shut down your immune system or overactivate your immune system.

I think one of the things I have just found out is that pharmaceuticals are a lot less targeted and effective broadly than maybe we have been led to believe. So looking for alternatives to that has certainly encouraged me in that way.

Chris Madden:
Marketing and healthcare is not just about conversions, it is about connection. Helping someone find the right program at the right time can literally change their health.

Nate closes with a fascinating look at the future, from psychedelics to light therapy. He reminds us that innovation is not just about new tech, it is about rethinking what care means and how accessible it can be. It is bold, it is human, and it is exactly what digital health needs more of.

Nate Purpura:
I am generally really interested in the potential for psychedelics broadly, to treat things like opioid use disorder, ADHD*, post traumatic stress disorder. I have got people in my family directly affected by all three of those, and I think the current sort of status quo treatments for those things largely have not been effective.

And so the more I was reading the research about psychedelics and microdosing and things like that, that have been taboo, gotten the scarlet letter for lack of a better way to describe it in this country, are really interesting, really helpful. And so just generally those spaces I find interesting.

Certainly I really like what we are doing at Rigo Health* for that right now. Light therapy for psoriasis and eczema, it is the standard of care around the world and it is so hard to get here in the United States. Why is that? It is a very cost effective treatment program, yet we put you in a ninety thousand dollar a year drug that has all these nasty side effects*. When for most people, that is not the right option. So I really like what we are doing here.

Chris Madden:
Success in a B2B two C model is not just about signing partnerships. It is about activation. You have got to earn attention, not just access. The brands that win are the ones that respect the audience, test relentlessly, and keep the human story at the center.

Authenticity matters more than ever, especially in healthcare. So build relationships, not just campaigns.

Of course, scaling reach is only advisable after understanding and addressing risk. Episode fifteen, our next episode, unpacks Privacy and Compliance – why staying inside the lines legally is as critical as standing out in your innovation.

Chris Madden:
If you're trying to win patients and build trust, partnerships can be a huge unlock. I've seen them help scaling companies grow faster, reach more people and even change health outcomes for patients. That's the power of teaming up with the right folks, whether health systems, payers, even influencers.

When it clicks, it's a game changer. This is Marketing Digital Health, and I'm your host, Chris Madden.

In this episode, you're gonna hear from leaders who know how to make those partnerships work. Clay Holderman has years of experience building collaborations inside of and between health systems. Joe Cannon, who we introduced in episode four, discusses how Hyperice tapped into pro athletes to turn them into megaphones for recovery products.

Kelly Idhe, introduced in our very first episode, talks about why Northwestern Medicine sees their physicians as critical partners.

But first, Nathan Purpura is a veteran growth leader in digital health with deep experience building D2C and B2B2C, and partnership driven models at companies like eHealth and Bicycle Health.

Now driving growth at Credo Health, Nate is known for his pragmatic approach to growth strategy, having scaled patient acquisition through a mix of direct to consumer marketing, health system and pharmacy partnerships and employer driven distribution. His work bridges brand building, data, rigor and collaborative go to market thinking, making him one of the most experienced voices in operationalizing growth in healthcare.

For Nate, the first move is simple. Get your sales team dialed in so you know exactly who you're targeting.

Nate Purpura:
It starts good sales team. You really need sit down with your sales people, probably your product people and your CEO, and figure out who's a really good fit in healthcare.

Your options are usually payers, small, medium, the large health insurers. Oftentimes it's health systems. Might pharmacy benefit monitor for PBMs and could be pharma, but that's a bikini channel to try and penetrate sometimes, sometimes you want to go and to B2C through medical groups.

They're brokers, they're large health insurance brokers, and even like the Brown & Browns, WTW, Willis Towers Watson, and groups like that.

Chris Madden:
Once you've got the sales team focused, Nate drills into a few important questions: what problem are we really solving, who's actually a good fit, and then, and only then, do you start the drumbeat of content and outreach.

In my experience, that's the key. Too many companies blast content without ever tightening the focus first. But when you know your target, suddenly the content hits harder and your campaigns feel less like noise and more like signal, because you're speaking to a focused group about their specific challenges.

Nate Purpura:
What is our product, what issue is it trying to solve in very basic marketing stuff? What's our product market set where we can sell?

And then from there you have to strategic know what can you support, can you handle what relationships you have. You don't wanna boil the ocean, you're trying to pick some verticals.

In some markets there might be regulatory issues that come into play here. You sell everywhere, whether of the easiest states to sell it to, but you really try to build the targeted list of folks that you wanna go after, and then some valuable content and messages to find, generate interest and drive leads into a platform and really basic marketing stuff.

And then from there you try to build a consistent campaign and like, what is our drumbeat, what are we saying that has interest in value, and you're really pushing that content out through, you know, the channels that you have available. Obviously LinkedIn's great for B2B, you know, so there you're looking at the companies, the job titles, and you're either using the tools they have to push to certain markets and genres, or you can go to a third party, like a alternative healthcare, something like that, and buy lists, you know, build custom audiences on LinkedIn or do email marketing.

Marketing, who are we selling to, what do we, how is valuable for them, what can we realistically afford to do and make sense to do, and then very methodically go target and distribute content and try and sort of nurture, pull through at a very high level.

Chris Madden:
That brings us to healthcare partnerships at the hospital system level. Clay Holderman is the CEO of Avia, a digital transformation and innovation partner to health systems across the US.

With deep experience in health system leadership, Clay now helps guide systems through the complexities of change management, applied AI and operational transformation, especially at a time when economic pressures, demographic shifts and emerging technologies are forcing an inflection point in the industry.

According to Clay, it's key to remember that there's no one size fits all here. Some hospital systems are building with the biggest tech players in the world. Others are scrappier, running small engineering teams inside their own walls.

Clay Holderman:
You see everything from those that are large enough to make partnerships with the mega scalers and really help Microsoft and AWS and others with their health investments and truly creating partnerships where they are helping by making their data available, probably most importantly, in a controlled environment, and helping train these large language models, and these agents within those models and those environments.

And that's something you see in the Mayo Clinic platform. You see a lot of the larger systems playing with a lot.

On the other end of the spectrum, a lot of health systems have brought in engineering teams themselves and are allowing their researchers or their clinicians to work with engineering teams internally, and then they want to be able to use that IP to make a broader impact outside the walls of the health system and have a return on investment on that IP.

And so you'll see companies like Abundant Alliance, which is a family of Avia, helping bring multiple health systems together to create companies out of their IP and then help invest and bring the scale in those companies.

So those would probably be the two ends of the spectrum, and then there's many, many startups where founders are coming to health systems looking for their first proof case or their second customer and health systems are taking equity and co-creation in exchange.

Chris Madden:
Case in point, when Clay was COO at Presbyterian Healthcare Services, they didn't just buy a product from a digital health partner. They collaborated with the team to shape and improve the product.

His team works side by side with Bright.md to refine triage models and workflows. That's not just partnership, that's co-creation. When it works, everybody wins.

Clay Holderman:
Our clinicians help to refine the automated triage models and the workflows and bring forward product improvements that really helped the product become better and helped our clinicians to reduce friction.

So lots of different ways that we partner in this space.

And Avia’s role is really to help bring together those partnerships, help advise on those partnerships, what are the conditions of success in those partnerships, and then also to help spread the word across our networks about how others can replicate these partnerships.

Chris Madden:
Now partnerships with big tech are one thing, but what about right at the ground level where doctors and nurses are working with patients every day?

Kali Arduini Ihde is the Director of Ventures and Innovation at Northwestern Medicine. We introduced Kali in episode one around why marketing digital health matters.

Kali from Northwestern says that's where the action really is, and if you're not showing up there, you're missing the heartbeat of healthcare.

Kali Arduini Ihde:
Sourcing is one of the main activities that we do, which is how do we find and stay in tune with what's out there, what's available, what's possible, and a lot of that is a combination of staying really well connected to leaders within our organizations.

So physicians are the best folks to tell us what they're hearing, what they're seeing, what they would like to see from technology.

So we partner very closely with our physician leaders, our frontline physicians, as well as nursing and administrators to understand what are the biggest problems, what do they want to solve and what have they already heard about.

And so that really makes sure that we're staying aligned with what the organization needs and what our workforce wants.

Then it's my team's task to go out and find out and stay connected with what's out there. So we go to conferences, we stay connected through, you know, the news, through forums, through networks, health systems that get together and share, because it's important to know what's available now, what are others exploring, what's early stage, whether it's coming from startup companies or some of the bigger players that are really wanting to disrupt healthcare.

But we also look across industries. What are we seeing elsewhere, what are folks finding, are there technologies that sort of span industries, maybe don't have as strong of a foothold in the healthcare industry, but could, and how can we be at the front lines of bringing that forward.

So naturally with a lot of the trends out there right now, things like generative AI and agentic AI are things that I'm talking about on a daily basis.

Chris Madden:
Kali makes a great point. Partnering with physicians isn't just about getting their buy-in. It's about listening to the people who know the pain points better than anyone. That's how you find the real opportunities.

And speaking of opportunities, Joe Cannon knows how to turn users into raving fans.

Joe Cannon is the SVP of Global Partnerships at Hyperice. If you recall from episode four, his company Hyperice makes recovery tools, and instead of going straight to consumers, they started with the professionals.

When LeBron James and Kobe Bryant use your product, you've got credibility before you even run an ad.

Joe Cannon:
When I started the company in 2016, almost every professional athlete had access to a lot of our technology. Now, we had a smaller suite then, but it's been core to our DNA and still is, and a growing part of our business.

When we build products, it's always in from the first product, and with Kobe Bryant and our founder, which was the ice pack, was the Hyperice product, which is where our company name comes from.

It was built with feedback from the world's best athletes, and it was if we could build something that they love, that they could use, that they trusted, then we could, and we, but we priced it at a price point that anyone could afford or reasonably anyone could afford.

We were onto something and so our goal was always to test and get feedback and get ideas and have conversations with those athletes.

That's why we don't chase a lot of trends in the wellness space, so fads in the wellness space. It's because the professional athletes aren't asking us for it, and it's not something that is coming up with their trainers and doctors.

So when I started my job as kind of the first commercial employee, it was really to help the brand get out to everyday people. And so that was taking what we learned from professional athletes and bringing that to the everyday person.

We focused on fitness first, but going back to the ego of our brand, which is very limited in the sense of, we're recovery, we're activation, we're movement enhancement, we're pain management. We are a piece of technology that helps you do the things you love better.

We don't necessarily need to be the activity or the main course. We are a partner to all movement, to all modalities, and so we have built our brand as a very partner centric model.

We want to be a part of what is happening in a space, whether that's an Equinox or a Lifetime when it comes to fitness, or in a Marriott or Hilton or Hyatt or Four Seasons in spa or in hotel rooms like we deliver with Westin.

So it's a very interesting kind of question in the sense of our brand is so partner centric, like we don't, we are okay showing up as someone else's brand powered by Hyperice. Like we do over a hundred Nike events a year, and most of the time the only branding we have is our technology being used by the athletes, the attendees, the people coming to the run club or the VIPs getting a massage or jumping the NormaTec boots.

It's not like, oh, this is a big Hyperice logo. That's not really our thing necessarily.

We believe in getting people in the boots, getting people to try the guns and really creating experience out of it. So I'd say what makes us an attractive partner to our partners is we do what we say and we say what we do and we deliver on time.

And we are really excited to be a part of it. And I think we're really grateful to do that. There's a quote from, you know, rugby, the illustrious, the greatest rugby coach of all time, Jack Clark. And he'd be embarrassed, I'd say that. But at my alma mater Cal, and he always says, grateful for everything, entitled to nothing.

And I think we are that at Hyperice. We really embody that as being really excited to be a part of what our partners have going on and being enthusiastic and being there.

And that's how we do things in every channel and how we approach it, 'cause our ultimate goal is not logo recognition on a billboard, it's product on people in boots, people seeing, touching, feeling, loving the product and saying, wow, I thought this was only for the world's best athletes, but it helps me move and feel better.

Oh my gosh, my hip hasn't felt this good, or I gave this to my dad for his back and the Venom has changed his life because he uses it every day in the morning.

Thank you. People name our products. That's amazing to us, like they name them like members of their family. They name Hypervolts, like, oh yeah, Jerry’s always working in our house and Norma, she just crushes the legs for all the family and we got the kids in there.

That to us is that we become part of the furniture and like the healthy habit at home. That's the dream for us. That's why we love partnerships is because people experience it and then, if that exit through the gift shop model where it's like, I really could use these NormaTecs because I travel a lot or whatever I do.

Chris Madden:
There's value in finding people just as passionate about your product as you are, whether that's LeBron James or your friend's dad.

Joe’s word of mouth is opportunistic, but can also be deeply fulfilling and meaningful when the health stories become personal.

Joe Cannon:
It never gets old seeing your product be used by the best athletes on earth on the side of the sidelines, like LeBron using the Hypervolt, or Anthony Edwards wearing the Venom Back wrap or on the sidelines of the knee or leg or shoulder or all at the same time.

That's amazing. But hearing that someone's dad who is going through chemotherapy loves the Venom Back because it keeps him warm and there's a lot of circulatory issues that come with that, or the NormaTec helped them overcome pain or in that way, during that really hard time.

Or even tragically like people's end of life stories that you hear that people are buying it just to, their parents have a little bit of comfort as they go. It's heartbreaking, but it's beautiful that our products can provide the relief people need to just move.

You lose sight of that. A lot of times you're, you mean brand partnerships or selling or you're chasing numbers and then you get these stories or these emails from people out of the blue or some of the stuff around the fire.

We had people here in California lose their homes and we had two different stories. One reached out on LinkedIn and someone I didn't know and said, hey, one of the things I grabbed with 20 minutes to spare was I grabbed my NormaTec, 'cause I use it every day and it helps me train.

I'm so glad I did it, but we're actually able to get back to our house. And so I just wanted you to know, I thought you might find that to be funny. And I found that to be heartbreaking, but amazing. That was something.

And we had a friend who lost the house and her son plays volleyball, and she was like, oh, he used it every day. I should have grabbed it. I didn't think about it. And so obviously we sent one. It's one of those moments that you're like, this stuff is really important to people.

Chris Madden:
I love that as a clear expression of Hyperice having this partner first mentality. They're okay being in the background as long as the person's experience delights. That's what makes them attractive partners, and good partners are deeply trusted because it's not about hype, it's about the results and the proof of people actually feeling better.

And Nate sees it the same way. For him, a good partnership is when both sides win. The health system gets healthier patients at lower costs, and his team gets to prove their solution really works.

But that kind of collaboration takes trust and careful navigation of regulations and privacy rules.

Nate Purpura:
Generally, a good partnership from a service provider standpoint is they've got a sizable population that, you know, there's a match there in terms of they've got people that need it, we can provide it if they're willing to enter a BAA and do all the compliant things to actually give your MX analytics team access to the data claims and help determine who in your pool of patients is what can fit for our program, and then allow us to do direct marketing, particularly if it's co-branded.

That's typically the most effective way to build a program. The nice thing about that too is that if our data analytics team, let's say your data comes back because this is the patient population that we think is really good based on claims history, we know that we can address these issues.

We see that the last five years they didn't cost X amount of dollars. We know our average patient's gonna cost five, ten percent of that. It's a real win-win.

And then we have a prospect database we look at and we know, okay, here's everybody that we reached out to. Once we run a program and we see who actually signs up, we've got a real good foundation for segmentation too, right.

Look at, these are the messages that we used, value propositions that we, we got 20 percent of that market to respond and 10 percent to sign up. So we converted about half of the leads that we got, whatever, right, whatever the number is. Here's these actual signing up and then we can tweak our offer.

We can go back and say, okay, let's try something else from a marketing perspective, 'cause we missed 80 percent, we missed men over 50, or women in their thirties or whatever. And if we can look at the claims data and go, we didn't make a good, we weren't, we didn't make an appealing offer as somebody who's hasn't been in treatment for three years, but anybody who's been in treatment in the last six months was into it ever.

You sort of segment out and figure out who's responding and who's not responding, and then you can share that back with the partner too. We say, look, this is a group that, you know, we're just missing from a marketing perspective or we talked to our enrollment team, it worked out that actually they weren't a fit for the, and so we either need to update our service to help service this population, or we should redirect those folks to something else.

So that's really the foundation of a good partnership. And if we're a good servant of your goals, we are a good partner.

So if your goal is to keep people healthy and lower their costs and lower the costs on your system and we help you do that, it's a great partnership.

And then it's all about transparency and we all the work for it. There's so much privacy and regulation around data privacy and healthcare that you have to be really careful and take that very, very seriously and build a lot of trust.

But if you do that, you can work out, you build some fantastic partnerships and have, you know, tremendous success.

I generally tell people like, the juice is worth the squeeze. If you can do these kind of programs, set it up the right way, it is very, very high value because typically from an acquisition standpoint, a member acquisition standpoint, it's a very cost effective, but it's very low cost to go acquire these patients once you have the program set up the right way.

And then these programs typically perform well. Most digital health, virtual health startups don't really make it out of incubator stage if they can't prove that they have good outcomes.

Chris Madden:
What stands out to me here is the transparency. Nate’s team looks at the data, shares what's working, admits what's not, and adjusts. That's the mark of a strong partnership, and it's also the only way these programs survive long term.

Next, Joe again highlights Hyperice partnerships. No matter if they're hospitals or physicians or celebrities, they're all centered around the same thing: reaching people, getting them to try the product or tech and simply making them feel better.

Joe Cannon:
The goal is once someone tries it, it's like, did that relieve their pain, did their hip feel better, did their lower back feel better, do they feel like they recovered faster from their run, do they feel less stress after using the products.

That's the type of stuff where that's common across the whole human race, everyone wants to feel better. No one wants to be in pain. Your brain's primary function is to keep your body out of pain.

And so it's like, what do you want more than that? I think we satisfy a basic human need and a sense of comfort, and so I think that's pretty common across all of them, and it's just figuring out what is the connective tissue that we can reach with a partner. What can we provide.

And I think so many times, like we talk to partners and we figure out what they have going on.

We're not usually going in with a pitch on, here's this box, put this in, do this, the end, here's the program, call us if anything happens. It's, hey, what's happening in your gym, what's happening at Fort Benning, what's happening there with basic training, how many people are you bringing in, okay, how can we provide support.

How is that different than what we're doing with the SEALs and Naval Special Warfare at BUD/S. It's having those conversations and better understanding what they need, the tech they need, and not just selling them whatever the box is, selling them something specific to them and providing them support that they feel taken care of.

Chris Madden:
Nate details how COVID changed the healthcare industry. It opened the door to telemedicine and virtual care in a whole new way. Some companies are less progressive than others when it comes to virtual care.

Being a good listener and having people skills is a strategic way to build trust in those partnerships.

Nate Purpura:
Now, COVID sort of opened the door to telemedicine and virtual care in a way that it hadn't been opened before. So I think very often when talking about a health system, it just depends on how progressive they are, so what their business partners are like.

Sometimes they're very protection. We've got a massive facility downtown in a region where we're large employer and there's some resistance to virtual care, and other places know that organically expand access.

Probably a really good sales team. We CRM a good process document, what are the conversations that we're having, what are we hearing, is that a pain point that we can address. Those are all those sort of human skills and human conversations around being a good listener and being a good problem solver.

And then from marketing standpoint, the best way you can help that group typically is good CRM management. So who are our leads, what conversations are we having, keeping track of those things, making sure that you have answers.

Helping that team stay focused, supporting them with assets, resources, a lot of this sort of traditional MarCom stuff like what's the best deck, do we have options, have FAQs, you know, those kind of things.

Chris Madden:
Having marketing collateral, leads, a focused, targeted list of accounts, you are ready to roll and things get exciting, but don't get too excited.

You have to size your partnerships based on what volume your company can handle at the time. You don't wanna reach too many potential patients too soon if you aren't operationally ready yet.

For example, if you have only a handful of clinicians and 30 more appointments to fill per week, you don't want a massive enterprise partner to flood you with thousands of patients that you can't handle.

Nate Purpura:
You wanna know as best you can, as early as you can, what your member acquisition program is gonna deliver.

You really have to think about it from a direct response basis, so you're not doing brand marketing, you're not doing very often, you're not doing general SEM, you're not doing general direct to consumer tactical things.

You know, you start putting a message out there and you're opening the doors, you're trying a bunch of different strategies and tactics to try and create awareness to drive people in.

With B2B2C, it's very direct response. So typically, I know you have this issue, we treat this issue and we're gonna try a bunch of direct response tactics to get in front of you, make you aware of it and see if you convert.

And once you know how those things perform, then you really gotta be able to scale it from a support and care standpoint.

I wouldn't wanna go outreach to a hundred thousand patients if I can only handle four or five thousand. So supply, very often it's like, where are you at in the company, how many people can handle the lot, other you donation drive, gas acquisition campaign that drives a bunch of leads in and your sales team got through telephonic enrollment, for example.

Or you need to onboard patients with other humans and you overwhelm that group, 'cause then you burn your credibility with the partner and with the number. And I called, I outreach, I couldn't get an appointment, that sucked.

The next time I email that patient or, you know, mail them, call them anywhere, acquisition status is, they don't have any trust and you can actually deliver.

So that's usually the first barriers in understanding what is your threshold from servicing. And then you can build off of that, right. We can service this many leads. We could service this many patients. We think our marketing is gonna drive four or five, twenty, fifty percent response rate. So you back into the math that way, right. And that's really where you start.

You know, tactically if you're going B2B2C and you want to deploy digital channels outside of something like TV to frequent example, targeted digital, you know this, you need to have, you know, usually about ten thousand records to build some audience.

There's a lot of areas to that too, from a HIPAA compliance perspective, is do, does the partner have opt-in for those kind of communications, what are you communicating.

I typically recommend like build your content strategy around, at least from a branding, a digital perspective, build your content around what I call value added communications.

There's a CMS for Medicare and Medicaid Services standard for value added communications. And I use CMS guidance 'cause they are the strict, so if you're adhering to CMS rules and you're pretty much covered for people on exchange plans or people on Medicaid, things like that. Medicare's typically restricted.

So in that arena, you know, you're never saying, Chris, I know that you've got ulcerative colitis or cataracts or something. I, you never say that.

What you can do on a digital platform is just general education. And now, do you know that treatment A is now available for people with cataracts and here's why it works, and you maybe don't, you typically don't promote your company so much as what it does.

You know, one issue is gonna be just distribution. What is your product and service, right. Can you get it. Typically the value proposition to the end user where the partner is digital health spaces, where we're gonna lower your costs.

We just have a massive lag of access to clinicians and treatment options through most of the country. There's various businesses that I've been in. The problem is better or worse, but it typically takes two to three weeks to see a specialist.

In some cases, things like opioid use disorder or rehab, opioid use disorder treatment program. Either if you get on a plane and fly somewhere, 'cause there's just nobody in your area. And very often what you're doing in the digital health space, you're offering digital access to a clinician or a treatment program.

And then that program is a high value in terms of getting people into treatment and keeping them in treatment.

That's often the sales point of like, we've got virtual, we've got really good retention because it's less expensive. The patient can do it from their phone or they can do it from home. So they might have to take an hour from work or get in the car or drive somewhere.

So a lot of the value with these programs is typically like access and adherence to treatment, 'cause those bring cost out some more preventative care, more upfront treatment.

So at the end of the day, that's what you're offering is, is we'll get more care to your patients sooner and keep them on it so that we bring your costs down. And that's obviously very appealing for employers.

It has some appeal for payers. The pharma can, it can get tricky. It depends on what your product did. And then same thing with health systems. It just really depends. For things like mental health, sometimes there's a parity issue where they wanna make sure they've got a treatment that they can offer, but they don't have enough clinicians in house.

And so when you bring a virtual offering there for something like addiction medicine, where there's not a lot of specialists, if you can centralize virtual care for them, that's sort of open value you add.

Yeah, it just really depends on the offering and the vertical that you're going after. But generally it's better access, better adherence, better health outcomes and lower costs.

Chris Madden:
According to Nate, creating awareness is the best thing you can do when you're doing a targeted B2B2C outreach program. A big part of that is general education.

Nate Purpura:
The people that you're outreaching to just get awareness of, oh, I didn't know that medicine for opioid use disorder was available, or that I could do virtual care, virtual cognitive behavioral therapy through an app.

That's fantastic. That's really interesting. You know, this company's telling you about that, so you create some wellness on digital channels instead of like the best thing you can do when you're doing a targeted B2B2C outreach program.

And if you can time that around when your direct response, so let's say your partner's going to email their members or mail them, or you're gonna do a series of outbound calls. If you lay the groundwork ahead of time to create awareness of this great new treatment program, that people are aware of it and are interested in it, and maybe they click through your ad and go learn on your website, but they don't know that it's covered, then when you follow up with a direct offer, you'll increase your risk.

That's right in your conversion 'cause you built a trust there. So in terms of thresholds, that's where digital becomes high value. But you need to have, you need to be able to do it and you need to be able to build a custom audience that way.

And you've gotta get a large enough population to come to your site and engage with content to be able both.

So that's really where having a partner agency that knows how to do things and can get very creative with you, or having a good skill set, a good team internally that knows how to activate from a digital marketing standpoint in a compliant way in the healthcare space.

Chris Madden:
Joe Cannon wraps things up with two very good points. One, when it comes to partnerships, don't get tripped up by contracts or negotiating for things that only work for you, over committing.

Joe Cannon:
Being too focused on the contract or things that just work for you. I see it a lot with other businesses where they get so obsessed with having every I dotted and T crossed that like they lose the spirit of the partnership.

Gary V said a long, long time ago, you always want all your partnerships to be 51 percent in their favor, if not more. And 'cause that will create more for you longer.

That's where people get tripped up is like it has to be a specific win in this way and that's where I see like struggles happening.

Chris Madden:
Joe's wrap up point number two. Wellness is having a moment.

Joe Cannon:
I think some of the stuff about reduction in chemicals in food is super important and something that we're happening, but I think the next phase of where this is going is MSK issues.

Musculoskeletal conditions are the number one reason for calling out of work, workplace absenteeism, a huge cost to our healthcare system, and right now in so many ways, we're not adjusting to that.

We are waiting until it ends. We're not being proactive and I think a lot of people are thinking about physical proactivity and like working out and training and running and HYROX having just a massive moment and what they're doing.

But I think long term it's like how are we taking care of our bodies to prevent breakdown. Joint replacements are an all time high and what are we doing to really slow that process.

We've been focused on this at NormaTec for 25 years and Hyperice for 15 on taking care of people's body, taking care of the world's best athletes' bodies so they keep going, so we can reduce these non-contact injuries we see from repetitive strain.

And that's what we're seeing in general pop too. How can we do that in a way that really helps allow people to get out ahead of it and really provide research that allows healthcare companies to make those decisions.

'Cause right now people are voting for that with their healthcare dollars. They're getting saunas. They're buying red light panels. They're buying cold plungers. They're buying NormaTec and Hyperice products.

And in so many ways, NormaTec is medicine. NormaTec is a class two medical device that has over 30 years of medical research that has all kinds of incredible outcomes and some things that weren't even contemplated.

There was a study that came out about NormaTec affecting arterial stiffness in younger populations. What does arterial stiffness have to do with anything. Yes, there's some physiological benefits, but there's some massive benefits for cardiovascular health reduction.

How does something as simple as the NormaTec pneumatic compression device affect outcomes that are not just joint or soft tissue related or diabetic wound care related or lymphedema or DVT.

All important issues, but how can it improve cognitive function, how can it improve cardiovascular health. The outcomes there are pretty crazy when you think about where this can go from the use of this product that was built for post mastectomy lymphedema in the late nineties, right.

There's some pretty crazy outcomes that are coming, and I think we're at the forefront of learning it. It's just we need that healthcare adoption and that conversation with healthcare leaders, payers, partners, and doctors to say, hey, we're already doing this with the world's best athletes. We're already doing with this, with special forces in the military.

Well, why aren't we offering this to people who are working in construction and warehouses and otherwise.

We're super pumped about it at Hyperice, what's to come and how we can really begin to impact healthcare policy and healthcare services.

More than that, preventative healthcare is the future of healthcare, and we want to get there.

Chris Madden:
And that's what I love about this conversation. Every guest in this episode from Nate to Clay, from Kali to Joe, sees partnerships as about long-term connection and never about transactions.

They're about trust and human relationships. They're about delivering something meaningful and valuable.

If you take anything from this, let it be this. Find partners who care as much as you do and treat them like teammates, not just channels.

That's where the magic happens.

Sometimes growth comes through others. Episode 14, our next episode, takes you inside B2B2C models, showing how covered populations built via employers and health plans are reshaping digital health acquisition.