Rich Briddock: “In a way, behavioral health has been on the forefront of low-acuity direct consumer marketing. That’s why when you compare the kind of marketing that you see in behavioral health, it’s much more sophisticated often than you see in other healthcare verticals. I think the competition is fierce and during COVID that was fine because the demand was so great that the supply couldn’t even keep up with that demand. It didn’t necessarily matter how sophisticated you were as a marketer in the space because there was so much demand out there. Now that COVID has receded and you’ve got all these companies that are now established and that are huge, you have a good amount of supply and maybe the demand is more competitive.”
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Lauren Leone: Hey, everyone. Welcome back to Ignite Digital Marketing Podcast. This is Rich Briddock, our SVP of strategy and analytics. I’m Lauren Leone, your host and SVP of client services here at Cardinal. Rich, it’s been a few months since I think we got together and we’ve been on the roadshow visiting clients, attending conferences, expanding our skillsets and knowledge base in healthcare. We’re back at this table to discuss what we have been working on together for probably seven years now, which is behavioral health marketing.
We thought as two people who’ve been in it about as long as telehealth virtual therapy has existed, that we would get together and share some thoughts, tips, tricks, what’s working, what’s not working, and just bring some knowledge to y’all. Rich, I thought it would be interesting to reminisce back into when we first started working in behavioral health marketing, which I think was around 2016, ’17. We started working with a group. There was a lot more traditional brick-and-mortar in-clinic therapy and psychiatry. What really changed the game was COVID.
The speed to which behavioral health is probably one of the first verticals to get their services online and start offering them virtually within a week of the world shutting down. At that time, the mindset in behavioral health was build it and they will come because the demand for the service was so much greater than the number of people that were able to adapt that quickly. I think one of the biggest things we’ve seen is that is no longer the case in the marketplace that we’re working in. In that vein, what comes to mind for you as some of what maybe worked really well back then that has changed?
Rich Briddock: I think that’s a great question. For me, I think COVID was probably something that was the flywheel for something that was already in motion with behavioral health, which was the aggregation or the emergence of big direct consumer retail-esque behavioral health brands. Brands like Talkspace, BetterHelp, and now there’s a plethora of those brands. Those were the two big ones that we were tracking back in the day. Now there’s Talkiatry, Cerebral, there’s tons and tons of these guys who are probably experts more in direct consumer marketing as well as the deliverance of care and behavioral healthcare.
In a way, behavioral health has been on the forefront of low-acuity direct consumer marketing. That’s why when you compare the kind of marketing that you see in behavioral health, it’s much more sophisticated often than you see in other healthcare verticals. I think the competition is fierce and to your point, during COVID that was fine because the demand was so great that the supply couldn’t even keep up with that demand. It didn’t necessarily matter how sophisticated you were as a marketer in the space because there was so much demand out there.
Now that COVID has receded and you’ve got all these companies that are now established and that are huge, you have a good amount of supply and maybe the demand is more competitive. I think to your point you’ve got to be a little bit more sophisticated about your marketing. The other pressure that’s coming outside of just a competitive set, getting more sophisticated and getting wider is the fact that there are certain things that you now cannot do. [chuckles]
Lauren: Yes, it was the Wild West because you’re first to market and anything goes.
Rich: Anything goes, and now obviously a lot of things don’t go, especially in terms of when, and obviously it was inevitable that we’d get onto this given the timing of this podcast, what happened with BetterHelp and the FTC and the settlement that was, I think, $7.8 million where the FTC came down on BetterHelp and basically said, you’ve been using patient data for your marketing efforts even though you made repeated assurances to your patients that you would not do so.
The way that this was happening was that BetterHelp was basically uploading a list of patients into Facebook and into their display platform Prilio and then they were building look-like models off those patients, or they were retargeting to lapse patients. Anybody who had an appointment in the last six months or a year, they were re-engaging them through these social platforms.
Lauren: Let’s set the record straight there that these are retail-approved strategies outside of healthcare that is best practice. Even within healthcare for many years, that was what most organizations were doing. It wasn’t like this was something that was way out in that field that so very clearly should not have been done. It was that shift from, we’re going to treat healthcare like a retail brand and use retail strategies to, wait a minute, we’re still in healthcare, we have to adjust.
Rich: Yes. I would go further and say that a lot of healthcare companies are probably still doing that. [chuckles] That’s a whole other conversation for another day. You’ve got those restrictions now where you can’t leverage your own first-party data, according to the FTC and HHS, to go get more of the same or to reengage and reactivate those existing patients. That is a big deal because of changes that precipitated that, especially on the social side, whereby it used to be that Facebook had access to a lot of data and that Facebook would let you leverage a lot of that data in order to target audiences.
Then obviously with the Cambridge Analytica thing and all of the Facebook scandals around privacy and everything that probably precipitated the move where we are now with the FTC. Facebook started restricting data more and more. First-party data, your first-party list became more and more important, but obviously, now you can’t even leverage those. There’s a lot of challenges in terms of targeting that exist today that did not exist five years ago, and you’ve got probably a more competitive environment as well. You do have to become more sophisticated.
I think one of the ways that we’re tackling this with some of our clients is the building of first-party audiences that are native in the platform. I think we’ve talked about this before on another podcast, but the idea of this full-funnel strategy where you engage people at the top of the funnel with a video about the brand, you get them to engage with the brand and then you reengage with that audience inside of the platform itself, not on the website, but you target people who watch a certain percentage of your video and try and drive them to the site.
The FTC and HIPAA have no issue with you re-engaging people on an advertising platform. It’s just when you are leveraging data that you’ve acquired from them coming to your website that it becomes a problem.
Lauren: The re-engaging of prospective patients is their behavior in pausing on their feed, taking a few extra seconds to view your video. Oh, that’s interesting. I want to see what that has to say is the qualifying activity to say they’re a little bit warmer than my average female, 18 to 55, who just happens to live within five miles of one of my locations, or because I’m virtual in the entire United States, wherever I have insurance contracts. Their behavior and the way that they interact with your advertising is the qualifier. Nothing about them personally, who they are, but their behavior.
Rich: Yes, that’s right. It’s like you’ve got a massive audience at the top of the funnel and then you’re sifting people through it. You may go from an audience of a million people or two million people at the top of the funnel sifting that down to 10,000 in the middle of the funnel, and then they’ll go to your website then in theory you can still do pixel-based remarketing of people who have visited your site. Although again, this is something that has to be done delicately now. You’ve got to know what is and what is not acceptable from a compliance point of view.
That’s something that, I always like to say, we are not legal experts. We do not give out legal advice and we cannot tell you if you are compliant. That’s something that your compliance team has to engage you on and give you advice on. We got off a little bit of a tangent there, but the other thing that I will say around COVID, the big change that pushed was obviously going from smaller, less consolidated providers that were more geographically located to your point because they were seeing mainly inpatient visits to these huge providers that were seeing state-level telehealth and telepsych visits.
The fact that telehealth and telepsych is more competitive because you have telehealth-only providers. BetterHelp is telehealth only, Talkspace is telehealth only, they don’t do in-person. You have to have a really strong virtual telehealth strategy. You can’t have the same strategy for in-person patient acquisition and virtual patient acquisition. Obviously, you’ve got to be on virtual and online specific keywords, but you also should have virtual and online specific audiences, virtual online specific messaging, virtual online specific landing pages that talk about the benefits of getting telehealth treatment.
It’s interesting that there is a sense among providers that virtual care isn’t as effective as in-person care. I don’t know if reliable is the right word, but in-person care is still deemed to be more the gold standard versus virtual care, but for patients, they don’t perceive it to be that way, at least in studies that we’ve looked at. I think what patients care about is just getting access to care in the most convenient way, but I think certain companies in the behavioral health space do a great job of showing why they have advantages in the telehealth space.
It’s either easier to connect to an appointment, it’s easier to make an appointment, they’ve got a whole app that goes with it that charts your progress, where you can reschedule things. They just make it very easy from a virtual engagement point of view that a lot of smaller shops or hybrid shops will not have. Of all the areas, it’s the one with the most opportunity because you can find patients in your entire state. If a provider is licensed in that state, which gives you a far greater audience to target, but it’s also the most competitive.
Even though the biggest opportunity is there, how do you compete against these companies that have really made it a fine art in terms of how they engage with people looking for virtual care?
Lauren: Let’s draw back to that because our foundation and behavioral health and very much our current experience with Lifestance as an example, is still brick and mortar in-person, therapy, psychiatry, and we can talk about the shift in service availability in a minute, but the concept of while the virtual have an advantage in certain ways, they’re making it more convenient, more accessible. They cannot physically see someone who may need to be seen in person or who may prefer it, and they cannot tap into a massive segment of users that still are seeking local care.
You’ve got trends like when a client is opening a new facility, it’s not always this grand, let me do a huge awareness campaign. The fundamentals of let me open my Google Business Profile, let me make sure my Psychology Today listing with my address is accurate properly links to my online scheduling, properly links to my website, has a great business description, is still one of the most important things you can do for those business before you even start thinking about I have to do a big marketing campaign to brand myself. There is still therapists near me volume that has continued to trend up regardless of the growth of telehealth as well.
Rich: Oh yes, absolutely. I think the local play is a massive one because ultimately the tenants around effective local marketing still exist. For behavioral health and are the same as any other local business in that it’s, how far away are you from me? How convenient is it to come in, like when you see me and how good are your providers? Those are the things that people really care about from a local point of view. Your reputation, your convenience, et cetera, your location, those things still stand firm. I think what I was more alluding to is it’s beneficial to have almost two separate strategies. The localized strategy is hugely important still, but then that virtual strategy layer is also critical if you offer those victuals.
Lauren: If you offer it, then get the best of both cohorts of marketing strategies and available patients.
Rich: Knowing how important it is by different service types or the treatment types, so medication management lends itself much more to an in-person treatment type, or at least the initial treatment probably needs to be in person. Not always. You can do some medication management wholly virtually, but it’s definitely not as easy. Whereas individual therapy, there’s almost no difference between in-person individual therapy and at-home individual therapy. It’s more the preference of the patient, but it’s much more easier to prescribe certain medications if that person comes into an office.
Lauren: At least initially because we’ve seen a massive trend in virtual-only medication management, and oftentimes what those groups will say is the majority of the work that they’ll do is in maintaining medications that a patient may already be on. They may even go as far as to explicitly state that we are not the initial prescribers. Some do have MDs on staff and they can both assess and prescribe initial and then maintain or adjust prescriptions over time.
Some are truly NPs that are trying to make it easier for someone to, let’s say, get a refill of an Adderall prescription that would otherwise require them to take an hour and a half off of work physically go into a facility where there’s a very quick assessment and then a issuing of another month’s worth of the medication, and so they’re trying to break down the barrier of people who are maybe not maintaining their medication simply because it’s not convenient to do so.
Rich: Right. Absolutely.
Lauren: We’ve seen that trend as well, and I think another one worth mentioning while we’re on the topic of how service availability has changed are some of the higher consideration procedures in behavioral health around treating people who are maybe resistant to medication, or have tried over and over therapy and medications. We’re talking about things that do require in-person like a ketamine—
Rich: Ketamine infusion.
Lauren: Ketamine infusion or transcranial magnetic simulations, TMS treatments, and these are services that we see more and more groups offering as extensions of care to what they already offer. There are a few that are trying to enter the space as only providing those, and essentially relying on the referral either from a group that doesn’t have the capability or sometimes a self-referral from a well-educated patient that’s out there doing their research. This is an advantage to the practices that do have facilities because they can add on these additional services and essentially improve the long-term outcome for the patient.
Rich: There are important things there to understand from a marketing point of view is patients may realize that they have treatment-resistant depression, but oftentimes they won’t know what the solutions are for those things. If you think, oh, okay I’ve got a TMS location in this market and I’m just going to throw up a bunch of keywords around TMS, you may be analog, because the search volume around that solution might still be very low because even though TMS has now been around for a while, it’s not that well known in the patient world.
It might be well known in the provider world, but not so well known by patients. There’s a lot of education that has to go in around people that have treatment-resistant depression and quite a bit of audience sculpting in terms of how do we find these people who potentially have treatment-resistant depression? What kind of things would they be searching for? What kind of articles would they be reading online? What kind of content would they be engaging with because they might not specifically be seeking out the solution?
I think the thing that we’ve been talking about earlier about the video approach with the Siff, that’s something that we have and are currently executing for TMS campaigns because obviously there’s tons of volume around depression, but then how do you find those people who need something more than just therapy or need something more than medication management?
Lauren: I think the groups that I see succeeding the most in that are the ones that truly take an approach of, I want to find the individuals who are reading about depression or whatever it may be, and my number one mission vision of my organization is to educate them. That there are better other options. We know that you may have been through it, and you are just seeking anything and everything to help you understand what other options do I have.
It’s in the strategies that I just want to find people who want TMS right now in my clinic, where you tend to see that race to the bottom and that desire just to earn the patient is not going to yield the volume or the efficiency that you may be looking for. When your mindset is to truly educate and then you can bring those people along. Category awareness and then brand awareness and then service awareness and then appointment availability. Those are the groups that seem to be doing it the best.
Rich: I think also the groups that can speak to the outcome of these things, because, I’m not an expert on TRD, but I understand that a lot of patients who have TRD are frustrated. They’ve tried a lot of different things, they might have been in therapy for many years, they may have tried a number of different medications and now they’re at the point where some of them are getting to the point where they just think that nothing is going to work for them. Obviously, talking about things like ketamine infusions and the TMS machine. Some of the actual procedures themselves, and this is what we talk about with some of the companies that provide these services can feel daunting, and so it’s more about talking about the outcomes because that’s really what’s motivating them is can this finally work where nothing else has worked? Making sure that that is the focus of your marketing efforts. You have to educate them on what it is, but really it’s more you’ve got to educate them on what it will do. Then in order to make sure, the other thing that we should mention, especially around ketamine, is it can be restricted, so advertising–
Lauren: Literally restricted [crosstalk] platforms.
Rich: It’s literally restricted, so advertising on ketamine is something that you can’t just do. You can’t just throw a bunch of ketamine keywords on Google, ketamine infusion, ketamine treatment, and then have it plus all over your landing page and website and advertise on it because Google will flag you and be like, “Hang on a minute, ketamine is a controlled substance. What’s this all about”? You need to be a LegitScript, certified in order to run ketamine infusion ads, I think it certainly also helps to provide [unintelligible 00:20:13] ketamine, although I think there’s more leeway around that because it’s FDA approved, et cetera.
Again, another thing to think about if you’re getting into these specialty treatments is there are certain hoops that you probably have to jump through on some of them in order to advertise effectively across different channels. Same for Facebook as well. You have to be a LegitScript certified, otherwise, you’ll get flagged and disallowed. Just make sure you understand the requirements before you get into these activities.
Lauren: I think that’s a great leeway into, we’ve been talking a lot about traditional behavioral health like outpatient, how am I going to talk to someone or get a medication? It’s a spectrum and we do have quite a few clients that have both inpatient or partial hospitalization programs, and then they’ve got intensive outpatient programs, and then they’ve got your traditional, just outpatient on-demand services. LegitScript applies more heavily in some of those more residential or inpatient type of treatment. That can be for anything from drug and alcohol to mental health.
We have a lot of clients in the teen, mental health space, we know that’s an epidemic in our country. Probably exacerbated by COVID and everything, the move to a very digital and socially influenced world. On top of that, then there’s segments within that in the eating disorder category. There’s a lot of different programs there. We’re going to pause there. We’ve just talked about low-acuity behavioral health marketing, and we have a lot to say in this area. We’re going to split this up into two episodes. Next time Rich and I are going to talk about some of our higher acuity, less retail-based behavioral health verticals like residential treatment programs, ABA therapy. For now, please, share and subscribe on Part One of our Behavioral Health Marketing Tips podcast, and we’ll be back in a week.
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