Marketing’s Role in Orthopedics with Haley Hodgkins of Triumph Orthopedic Partners

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Alex Membrillo: All right, guys, y’all are in for a treat. I’ve got Haley Hoskins on here, VP of Growth, right out of Nashville, Tennessee of Triumph Orthopedic Partners. Haley, welcome to Ignite.

Haley Hodgkins: Thank you, Alex.

Alex: I haven’t even had that much caffeine today. How about you?

Haley: I’m awake now. [laughs]

Alex: [unintelligible 00:00:40] Haley, so we’re going to talk about your ascent at Triumph and all the fun marketing stuff we’re doing because we got marketers listening to this so I like to get really, really tactical. Talk about cool stuff you’re doing, how do you think about your team? How do you think about growth? What you prioritize? How do you balance B2B and B2C patient acquisition because orthos get a lot of referrals and I’m sure you’re in charge of all of that, so we’ll get into that. Before we do, tell them where you come from. You grew up in the biz.

Haley: I did grow up in the biz. My father is a retired orthopedic surgeon. He was in private practice for 30 plus years in San Diego, and I spent my summers working in his office. This was before EHR, so I was alphabetizing paper charts. This was before HIPAA as well, so I spent my summer working for him. My mom was his practice administrator for a few years as well so I grew up around orthopedics. I love the space. I think it’s really interesting. It’s like five businesses in one. You’ve got surgery, you’ve got physical therapy, you’ve got imaging. It’s really a unique space. I’m not an MD, but I’m business side and I love working with orthopedic surgeons.

Alex: Yes, very cool. Grew up in the business. Growing up in a family business gives you a certain kind of hutzpah where you got to get things done and you learn a lot about a lot. You also were at Deloitte and you’ve done some stuff and then you got into this private equity game, and plays that giant where you could shine on the orthopedic front. Talk about client service line. I’m seeing this a lot more, you want the whole continuum care. I see lot of orthos bringing up PT [unintelligible 00:02:10] because all of that are taking the PT business. What are those service lines? Where do you focus the growth attention, parts one and two, but talk about what you focus on from a marketing perspective to support those.

Haley: There’s really five major service lines, at least with our platform investment, which is a group called Georgetown Joint Surgeons in the Atlanta market. There’s regular clinics, so that’s you hurt your knee, you go in to see the doctor, that’s your normal clinic. Then there’s physical therapy, as you just mentioned, there’s MRI. A lot of these places are bringing the MRI and imaging machines in-house. There’s outpatient surgery centers, which I’m sure we’ll talk a lot about on this, and then a lot of places are also doing these walk-in clinics as an alternative to go into the ER for orthopedic specific injuries.

It’s really five businesses in one. The primary driver of the business is the outpatient surgery center. That is where we focus a lot of our time just thinking through how to optimize the ASC. Our practice in Atlanta owns their ASC, which is a huge differentiator so we’re able to own the whole continuum of care.

Alex: You allow other providers to come do surgeries in there, or it’s just for Georgetown [unintelligible 00:03:18]?

Haley: No, various from there, 100%, yes.

Alex: What does the marketing funnel look like? Do you advertise to get people– Obviously I know some of these because y’all are a client, but do y’all advertise to get people in? I took my ACL, or you’re just orthopedic surgeon, back surgeon, shoulder surgeon and then we want to get them in for consult, get them surgery and then hopefully they continue to do the PT if they live in [unintelligible 00:03:41].

Haley: Absolutely. All of the above. We focus on getting them in the door for orthopedic injuries, knowing that then we can pass them along through all the other service lines. We get the occasional person that might just come to us for the physical therapy, but it’s typically the people that saw the providers for the surgery and then continue on with us.

Alex: Yes, because that’s a value add, that you’re going to have an orthopedic surgeon checking in on your recovery with the PT, right? If not, there’s probably a PT that’s closer to you if you don’t have surgery-related stay, maybe.

Haley: Exactly.

Alex: Talking about ACL and I ended up going with– Y’all weren’t client yet, so disclaimer there, but it was every year because it was run by the same surgeon, the Atlanta [unintelligible 00:04:19]. Anyways, [unintelligible 00:04:23] so that’s good. Then you have a B2B component, right too?

Haley: Very big compartment.

Alex: They’re referrals. Talk about what referrals and what you do to support.

Haley: B2B is really big in orthopedics because if you think about it, it’s different than other healthcare specialties like dental, primary care or OBGYN, it’s episode based. You would potentially go your whole life without ever– We would hope you would never have to see an orthopedic surgeon, right? You’re not coming in for a teeth cleaning every six months, you’re not going to PCP appointment every year. This is episode based, so we’ve seen a lot of success on the B2B side and nurturing those relationships with referral sources. We focus on PCPs, pain management, doctors, maybe some other physical therapy centers and then there’s a big employer workers comp strategy as well.

In terms of marketing, I think of marketing as our B2C efforts, which I oversee, and then I think of sales as our referral side of the business, which I also am a part of as well. It’s those things, but historically there’s been a really big success with the referral side of the business. We’re just starting to dip our toes into the direct consumer.

Alex: All right. That’s why y’all brought on the best agency of all time. On the referral side– That’s sales, so you guys have a head of biz dev and is there any support– Is that right? Is there a head of business? What are they called? Growth officer, what they–

Haley: At the trial level or at the practice?

Alex: I guess at the practice level. Georgetown Joint has someone out there that’s feeding the streets.

Haley: We’re actively hiring for that role if anyone listening is interested in the Atlanta area, we’re looking for a physician liaison, is what we call it. That person goes out and makes the connections with referrals, make sure that they’re happy, their patients are getting great outcomes, et cetera.

Alex: That’s the sales side. On the marketing side, you guys we’re launching into the ADC. First order business was website, talk to us about–

Haley: Website.

Alex: -yes, that process. You can also talk, you got a variety of different options presented for future acquisition. Tell us about the whole patient journey, how you fell through the website, why we have multiple options, et cetera.

Haley: Yes, so when you think about running an MSO, which is what Triumph is, and I should probably give a little bit of background. We’re an MSO, we were founded in 2021. We’re backed by Chicago Capital Partners out of Chicago, big healthcare Microcap investor. It’s a little bit of building at the MSO level, and then also helping our platform investment at Georgetown Joint. We built with Cardinal Support three website templates that will now go out to our future groups that partner with us and say, “Here are three great, awesome optimized templates.” You can give them a little bit of choice to be able to pick which one they want.

A big part of that is around our brand strategy, which is to not change the local brands. Triumph is a brand that will not be known by patients. We’re not intending to change the local brand. A lot of these practices were founded 40, 50 years ago. They’re really proud of the brand, they have brand recognition. We’re not changing that. It’s just modernizing the brand and bringing it onto a new website which we’ll support with Cardinal’s Health. Website is always primary focus. We got to modernize it, we’ve got to have great content, help with SEO, it’s the landing page. We need to have that down pat. That is always our first focus.

I would say our second focus is on Google listings, which Cardinal’s also done a lot of help around that with optimizing them. You’d be surprised, they might not even have a Google listing even though their providers are on Google. They’re really bringing them into the digital age. We do a lot of work around optimizing those, making sure there’s updated information. We also use a tool called Yext that helps push out all of our standard information across websites. I know you guys do work with that. I would say those are our core things that we do.

Alex: Are you running some PPC now?

Haley: We are running some PPC. Once we get the website in a good place, then we’ll run PPC to drive traffic there, and we’re in our third month of PPC with Cardinal, and I think the results have been really great. So far, it’s low budget to start, and we wanted to dip our toes in it, and also, it’s a tough market out there so we’re pulling back a little bit on spend, but really great results even with the spend. I think the Cardinal team’s been really scrappy on how to get creative with the keywords, how to keep their eye on the ball. We are doing some PPC, and so I also do a lot of work with our operational team to make sure that the conversions that we’re sending are then converting, turning them into greatness, having a great experience.

Alex: Are they going to listen to calls, are you checking intake?

Haley: Oh, I just got out of a meeting about that. We’re not seeing that currently, but we are thinking for maybe next year introducing some call tracking software. Be able to manage that channel.

Alex: No, we’ve got friends. Yes, yes, yes. You met one of them so yes, that’ll be good. Checking intake, and a lot of people think right now we’re getting a lot of pressure from being back partners, right? Everybody’s getting squeezed, interest rates are crushing everybody. You got to prove every dollar and we’re saying, it’s not just a marketing issue you have, you’ve got to check intake, you’ve got to check conversion, talk to B2B sales teams, everything. A lot of work to be done and a lot of the work marketing can do through call and lead tracking and checking how things are going on front office actually impacts operations and finance.

You got to get the whole team together, and that’s the fun stuff. Building our websites, this was something unique and Adam, a short smart guy he said, let’s build three templates. He had the right idea, not something we had done before, but very exciting. Let’s be honest, Cardinal’s not perfect. Was it a giant pain trying build three templates at once for giant MSO so that you had three different variations? I mean, that’s insane. We recommend others go nuts on that. Worth it–

Haley: I think it was worth it. It was challenging. Our whole ethos is we want to partner with physicians, we do not want to push a playbook to the practices. We want to partner with them and get their input. Having some optionality around that was our approach. Frankly, there’s often a lot of emotion around websites, like maybe they’re friends of website developers and put together. They’re really proud of it. We don’t want to take that away, per se, we want to optimize it, but we want to give them a voice in what their new website is going to look like. You’d be surprised a lot of people have an attachment to what they’ve done in the past.

Alex: I’m not surprised their brother’s cousin in the closet constructed it. Y’all’s acquisitions really want to stay on board. It’s a building thing. It’s not a sell-out, and they get an earn-out, they’re out, they’re really going to be a part of the MSO until, so say about five years. Very good. They’re going to stay on board and they have options there on how to maintain brands. What is the trickiest thing you’ve found in marketing orthopedic groups that you didn’t see come even having been in the biz for 30 years?

Haley: Direct-to-consumer is really hard in orthopedics because it’s episode based. I know I sound like a broken record here. It’s not relevant for me to push content to you. It must be a torn ACL or hurt your shoulder. It’s not relevant. It’s not like a lot of the other specialties. That’s been a challenge. We don’t do a lot of direct-to-consumer marketing. We do pay PPC, but we don’t push content out. Previously, we’ve had some good early success with because we’re really focused on finding people where they’re at, right? The vast majority of people are typing in orthopedic surgeon near me, or doctor near me. We’ve had a lot of success in that because it is very injury based.

Alex: Do you guys do anything for increasing the share of care? Someone comes in for imaging, making sure they’re getting SMS, email automations with educational content. Hey, you should come back. [chuckles] You got dude, you’d be surprised. I went to Emory. I’m going to say I went to Piedmont for the image. It was a clearly torn ACL. Nobody and nothing from Piedmont followed up to have the surgery done within their health system. I ended up going to Emory. Crazy, right? Do you guys do anything? Any messaging to existing–

Haley: We do a lot of it is around training the team. It’s around the default should be the next step they are going to be seen in our facility. They come in and they need an MRI. The default is that they’re going to our MRI machine. The default is that they’re getting surgery in our ASC if possible. We’ve done a lot of training around converting between service lines. We haven’t really done it on the digital marketing side. That’s a good idea for me.

Alex: I’m inquiring because it’s something I think I want Cardinal doing more of. We don’t have a lot of CRM and marketing automation experience but I’m hearing it’s half the equation. We’re so good at patient activation, but then patient lifetime value gets crushed because we don’t do anything after during the system, right? Who do you have to retrain, front office operations?

[crosstalk]

Haley: Medical assistants hold a lot of power. It’s a really, really important role because they’re writing up the charts, they are putting in the orders for where the patient needs to go next. We do a lot of work with MAs. Of course, the front office manning the phones.

Alex: Those people cycle, I imagine the 10-year is not long so that when they come on board, retrain, so it’s we’re going to stay with them and we go back through the whole rigamarole. Not easy to run a serious group. What are you excited about in marketing digital or otherwise?

Haley: I have been really excited about Google reviews, talking about getting scrappy, Google reviews, especially in environments like orthopedics, where people are Googling “Ortho near me, hurt my knee, what do I do?” That is where we’re seeing the most traction, we increased our Google rating volume by over 300% in the first 90 days using podium. Driving automated reviews, managing reviews, responding to them, people look at that. I know you know that, but I think a lot of our physicians didn’t really realize the power of that. People look at the reviews, they look to see if management is responding to them.

It’s hard to quantify, but I feel like we’ve seen a lot of new patient activation because our Google profiles are so strong. We’ve got that review volume and that average rating going up. I’m excited to keep driving that. It’s a low-cost thing, but really valuable. You have to remember a lot of these practices, these are family-run businesses in a lot of ways, right? They’re not necessarily sophisticated when it comes to marketing. A lot of the basics can really move the needle, the website reviews.

Alex: Simple as a PPC.

Haley: Yes, a little spend on PPC, it can really move the needle. I’m excited to just– I’m not scared of the economy that we’re in, because I think a lot of the basics are what we’re going to still rely on. It’s going to move the needle for our groups.

Alex: I love it. Everybody wants to answer that with TikTok or Facebook advertising.

Haley: The best form of marketing, and I’m sorry to tell you this as someone who runs an agency is word of mouth [laughs].

Alex: That’s okay [unintelligible 00:15:27].

Haley: It’s free, people trust people they know. The amount of reviews that I get in that, are so and so referred me, my neighbor referred me, my brother had surgery here. I’d say 80% of reviews say something to that effect. Word of mouth, activating that in your favor, it can be huge. Again, it’s hard to quantify but we rely a lot on that. It starts by making the patients have an amazing experience and getting them to talk about it, so that when you tear your ACL, and you ask your friend, where’d you get your surgery, they’re going to tell you.

Alex: That’s right. That’s why I love the email education ongoing because that patient if they just get a drip educational thing after, they’re not going to read to her, they’re never going to need you again. It’ll remind them I got to tell my buddy when their buddy, yes, something like that. I hear you word of mouth is number one. It is the best place, has the best patients, and from [unintelligible 00:16:20] number one, especially when you come from a family-run business provider group that’s been around 40 years. They grew up not by accident, but it’s by good care.

You have people like bad reviews and weird directory listings over 40 years. First six months should be spent cleaning that up and retraining them to care about it. Reminding them, the bad reviews don’t come from the providers giving bad reviews. The bad reviews come from the office because they couldn’t verify benefits, because they took too long to pick up the phone. That’s where I see the bad reviews come in. Focusing on the nitty gritty, and the simple stuff can be the most effective guys, y’all don’t have to get fancy. You heard it from Haley first. You know what they say about keeping it simple. That can be the best thing you can do.

Are there any trends in the orthopedic industry that you’re paying attention to? I go to all these healthcare B conferences, and the orthopedic lines are always well-attended. Everybody was in there. I remember I went to the wire woods. It’s a hot topic. Everyone’s trying to get into the ortho space. Are you watching any macro trends and you’re like, “Whoa, it’s going to be harder than we thought, or easier? We’re going to have a lot more PT clinics.” Any info on ortho insights?

Haley: Ortho insights, I would say first and foremost, consolidation is here. It’s coming and it’s here. Obviously, I’m biased working for an MSO. I think that it’s going to be really hard for private practices to survive going forward without capital partner and more leverage and scale. You’re starting to see that consolidation payer pressures continuing. It’s not unique to ortho, but definitely payer pressures and operational pressures, inflation. It’s just hard to run a business as a small group. Ortho-specific trends, I would say the move to ASCs versus inpatient is huge and increasing.

As technology and procedures evolve, we’re able to do more surgeries in ASCs versus the hospital. If groups have access to an ASC, and they own part of that ASC, that’s going to be a huge advantage. The flip side of that is you got to manage payers right to get good rates that you can do an ASC. Definite shift to ASC. We’re starting to see value-based care pop up in orthopedics as it is with everyone. Getting really specific on how you can track your outcomes.

Alex: That’s the hard part. I don’t know a ton about it, but it is tracking outcomes. It takes a lot of PE ingenuity, all the financial brains. Haley doesn’t just know marketing, she actually knows the orthopedics space well better than anybody I’ve met. Very cool to have you on Haley. Thank you for sharing. I love the Google My Business trend. It’s just the best thing to pay attention to because at the end of the day, you don’t have to drive net new patients all the time, guys. The existing ones that are getting word of mouth, they are going to check and do your own due diligence. Please do not go focus on that new patient acquisition until the hub before this folks, looks really good because everybody outside of Google, etcetera, will go look anyways.

Haley: Can I make another PSA?

Alex: Yes, PSA.

Haley: PSA do not drive volume to the practice until you’ve worked out your operational hiccups. Do not make the patient have a bad first experience. Make sure you’ve got operations in a great place before you drive the volume. Otherwise, you’ve got angry patients and it continues the flywheel.

Alex: I love that PS. The more you know. I love that because we get groups maybe even six months ago, we got groups that wanted to just go really hard. They want to ramp up patient acquisition really quickly. I tell them we will have problems driving efficient patients. We will not grow. We’re good at this. It’s not rocket science, at least to get to the point where Google is saturated. However, you are going to struggle, intake will not be able to keep up. You don’t have a centralized cluster. You’re not tracking what happens when they do intake.

You’re not reteaching the front office what to do. You have a random class. You don’t have a talent acquisition system. Haley, that was probably the best PSA. I want to start, I want to figure out that. Ashley Carley, I want to go big on that one. That was awesome. Haley, I want to make your first and final offer. I need you to speak at the Scaling Up Summit. I don’t know if anybody has told you about that, but it’s a launch I’m promoting on LinkedIn. I need you to speak at it. I want to a talk about it, and we’re going to have six more months of experience. We can talk about difference-

Haley: All right, when and where?

Alex: The December 5th and 6th on your computer. [laughs] You don’t have to travel. I was too cheap to do a real conference, so-

Haley: Hey, I respect it.

Alex: -I wanted to democratize conference attendance.

Haley: Yes.

Alex: That’s why I did online. Haley, thank you so much for joining Ignite. I hope your ear drums didn’t blast. I learned a lot. I hope you didn’t drain your brain. Thank you so much for coming on board.

Haley: Thank you, Alex. Always a pleasure.

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