Cindy Berger: “You’ve got to have your site and your content optimized for search engines. That to me, is the hardest part in a marketing playbook today. The algorithms change. Nobody has a magic bullet. No one’s ever going to get a magic bullet. I think the main thing with digital is, you can’t set it and forget it. Even if you think you’ve figured something out, it’s going to work for a week or maybe a month and then you need to evaluate: where’s trend, what’s happening, and what else do you need to add to it?”
On this episode of Ignite, our host and Cardinal CEO, Alex Membrillo, interviews Cindy Berger, a seasoned marketer with extensive experience in medical marketing, particularly in the dental support organization (DSO) space. The discussion touches on various aspects of DSO marketing, including the consumer-driven nature of the DSO industry, the benefits of DSOs for both dentists and patients, and the importance of reputation management in marketing. They dive into the challenges of marketing for DSOs with multiple practices, the use of technology such as call tracking software and email marketing for patient reactivation, and the need for marketers to understand the business side of healthcare. The conversation also hints at the evolving landscape of DSOs, potential changes in the industry, and the importance of providing a seamless patient experience in a post-pandemic world. Overall, it’s an insightful discussion that showcases the importance of a holistic approach to marketing in the healthcare industry.
Announcer: Welcome to the Ignite Podcast, the only healthcare marketing podcast that digs into the digital strategies and tactics that help you accelerate growth. Each week, Cardinal’s experts explore innovative ways to build your digital presence and attract more patients. Buckle up for another episode of Ignite.
Alex Membrillo: What’s going on, everybody? This is going to fun because we have someone that’s been around the block in medical marketing for quite a few years. One agent, won’t say how long, so you can say that for us, but from senior to DSOs and lots of DSO experience, this is going to be cool. I love the DSO space because it’s so consumer-driven, low acuity, very retails. It’s the closest thing to a purchasing decision to online or retail that we can find. I find that those marketers, my DSO marketers are some of the sharpest out there. Everybody welcome Cindy. Cindy, what’s up? How you doing?
Cindy Berger: Hey, Alex. Thanks for having me. Great to join you.
Alex: Yes, we’re going to have fun. Cindy is nice and warm down in Melbourne, Florida and I’m in Atlanta and I’m wearing a hat. I look like a five-year-old wearing a t-shirt because I like to go on walks while I talk. We’re not going to do that, but everybody is hot. This is August. I’m not supposed to date the podcast, but it’s okay. She can see the ocean from her house, from her room, so don’t feel bad for it. Cindy, how did we get from selling shoes online to Senior to DSO? Was it senior living, senior care, hospice? What was golden?
Cindy: It was all of those. There were about 245 nursing homes across the United States. We had a hospice division. We had assisted living. We had rehabilitation therapy to get folks well if they had a fall or a heart attack or all those other things. It was a nice coordinated care environment. Something bad happened, put somebody in the hospital, they’re not well enough to go home, they go to a nursing care and then we figure out how to get them better and get them back home.
Alex: The whole continuum, so-
Alex: -that’s a good feeling too. You can take mama all the way through whatever care.
Alex: You ended up in dental, you have a higher-ed stint. Nobody knows this about Carnell, but 20% of our revenue is actually higher-ed.
Alex: Yes, 80% still healthcare, but we love higher-ed. Dental, passionate about DSO, scaling out DSOs then I assume because you’ve been in it for a while.
Cindy: Yes, a little bit. The space is interesting. I think that it’s growing and DSO and consolidation is happening simply because there’s a lot of competition. If I were a single practice and a doctor, I’d be throwing up my hands to say, how am I going to do this, who am I going to hire, how am I going to do this business? The economies of scale, of having your back end, your marketing, your IT, your HR, all makes a lot of sense.
I think that’s what we’re seeing in the marketplace, and you’ve seen it as well, Alex. A lot of those single practices are matriculating with a particular DSO because it lets them focus on taking care of the patient and leaving the back end stuff, the stuff they might not love so much to folks who’ve got those skill sets.
Alex: I want to become part of a DSO, I hate that back-end stuff. Yes, I totally understand why they’re doing it. You would say overall, DSOs have contributed positively to dental care over the last decade. You’ve seen it be very positive, allows the dentists to focus on care and not on the business. That has been probably a very positive thing, you would say. DSO is getting a bad rap, so I think that’s fair.
Cindy: No, I think it’s a good thing and I think the other thing to consider is, look at the patient satisfaction scores. We’ve seen after we’ve on boarded a new practice and a new doctor, most of the time those scores go up. I think the patient experience improves with the DSO, or it certainly isn’t hurt from being a standalone practice.
Alex: I agree, yes.
Cindy: As a marketer, that’s one of the key things that we focus on. If you’re not taking care of reputation management, you’re not helping your DSO.
Alex: Yes, let’s talk a little bit about value propositions there. You’ve been at Dental Partners and Pure Dental, and I know we’re embarking on something fun, but Dental Partners, 50 plus locations, Pure Dental 43. You’ve worked on some pretty scaled-out ones.
As part of the value prop in the market you make, were they house of brands? Let me ask that question. Was Pure Dental house of brands, was it still like Dr. John here in Brookhaven, Georgia, or was it all Pure Dental branded? I’m not familiar with them.
Cindy: I’ve been on both sides of it. Dental Partners was a single-standing brand. When the practices were purchased, they were all changed to Dental Partners and I had a location extension to the name for the qualifier. Pure Dental brands was a house of brands. When you get to a house of brands, it’s a little bit harder from a marketing perspective, but the upside is the doctor doesn’t lose, the equity that they’ve built in the marketplace.
It just means, as a marketer, you’ve got a little bit more work to do. You’ve got different logos and color stories to integrate, you also have to be sensitive if there’s a specific voice or a style guide for a particular practice. You try and be sensitive to that when you’re dealing with a house of brands.
Alex: How do you do that at scale? Like every provider has their own thing? Were you tinplating a lot to a similar look, but they got to keep their name and change their colors, or did you say, that’s fine, we’ll work with what you’ve got? How do you do that at scale being compassionate towards 40 different providers?
Cindy: For a website, my personal opinion is having a template helps because then for the consumer, it’s a more consistent experience. They know where to look for navigational elements. If you then deploy a color story that aligns with the logo and the name, that tends to work. Then for the content that you produce, we didn’t vary the voice tremendously. My playbook for marketing is that it’s our goal to educate, inform, or entertain.
Not everybody loves going to the dentist. I tend to draw on humor a little bit to soften the experience or get them smiling or laughing along with me before I hit them over the head with all the must-do, can-do, your teeth are going to fall out if you don’t take care of the period issues, that sort of thing.
Alex: Yes, get them laughing first. You found hemming humor as part of your playbook. What are all the components of your playbook? It sounds like brand positioning is in there de novo. Do you get into tactics or is it just like that brand positioning of how you’re going to attack it? What’s in your playbook, how do you do it, how do you scale this out?
Cindy: The brand and the positioning, and it’s also getting some of the technical components. You’ve got to have your site and your content optimized for search engines. That to me, I think is the hardest part in a marketing playbook today. The algorithms change. Nobody has a magic bullet. No one’s ever going to get a magic bullet. I think the main thing is with digital, you can’t set it and forget it. Even if you think you’ve figured something out, it’s going to work for a week or maybe a month and then you need to evaluate where’s the trend, what’s happening, and what else do you need to add to it.
For some of the DSOs that I stepped into, the key things to do right away were figure out what changes need to be made for the website, do some SEO work, but then it was really getting specific and focusing on reputation management, paid search so that you’re bringing in a steady stream of new patients to help offset any attrition that’s happening with the patient base, listings and photos and video to help augment the SEO efforts. That in and of itself sometimes is a lot of work, especially when you’ve got to roll it out to 40, 50 practices to get all those things done.
Alex: Yes, you got to get good tools. We’ll talk about the tools. Educate, inform, or entertain, starts there, pre and positioning and then look at the bottom funnel, SEO, PPC, reputation management. I love that you said you can’t set and forget it. We just signed today an SEO project to audit, foresight, and then make changes, and I’m like, guys and then what? We’re going to make the changes and then what? They’ll rank forever? Cindy, thank you for preaching to the choir here. Yes, you can’t sit and forget it.
I think even the paid media landscape changes so much. With dental, you can now run LSAs, which are the picture ads that have been present in-home services for a long time. Even Google Ads has been standard. Things are changing there very quickly, so is the technology. Do you have favorite technologies that you use across these? You mentioned listings, reputation management are using technologies. Are you keeping GMB, all that kind of stuff in spreadsheets by hand? When do you invest in the technology? I just made a post about that. I’m curious what you think.
Cindy: I think that if you have 10 or more practices, you need to invest in technology and you can get out of spreadsheets. Some of the technology that I’ve used recently that I like works with Chat Meter, which has been great for reputation management. They’ve integrated AI to help you with your responses to posts. They also have a component that helps you integrate your GMB, which is handy and uploading photos. You can do holiday hours, you can do special hours without having to go into all of your individual GMBs to do things. I found that to be very helpful.
The other piece of technology, and I’ll say aside of my PPC agency because I think having an agency partner to help you with the stuff that’s not in your core skill set is really, really important. I get the basics of Google Ads, but I don’t have the skill set to say I’ve got the best bidding strategy and content strategy to make those campaigns effective. I think agency partners are important for things. For me, it was PPC and the other thing is to have an agency partner for SEO, because, again, it’s ongoing. You usually have a lot of work to do in a short amount of time, but then you have work you need to do-
Alex: It’s standard.
Cindy: -as it goes on. In addition to agencies, the other platform that I just started using recently that I love a lot, is a platform called Invoca that’s
call tracking software. They also break it down to call tracking so you know which your keywords are working in your paid search stand.
Alex: Yes. If you have it tied together, which you do, you have to put in some work to make sure it’s tracking all the way through the keywords and then uploading back into the ad platform. You heard it guys, Cindy says, SEO agency, PPC agency, I couldn’t agree with her more, and then she gave a very succinct answer, 10 or more locations. You got to start looking at technologies and outside resources. No more spreadsheets and trying to do it alone, I think that’s a very good answer. I have trouble with our video team coming up with an answer. I don’t know, once it’s holding you back, that’s when you make the investment. 10 locations in a multi-site provider group makes a lot of sense.
I don’t know if Pure Dental had a bunch of different, I don’t know if they were just GD or if they did the whole thing, perio, endo, and ortho. How do you know what each one of those types of patients wants and the messaging that’ll resonate? I imagine it changes because as millennials we’re aging and we’re going to need different things. Do you do focus groups, do you talk to the providers, what is changing, what do they care about? How do you gain insights into what patients care about, and in different markets they care about it and stuff? How do you do that?
Cindy: That’s a great question. What’s interesting, the pandemic I would say in some aspects was a little bit of a boom to the dental industry because I think people start seeing themselves on camera and they’re like, oh, maybe I need my teeth whitened.
Alex: [laughs] Look at my mouth.
Cindy: Oh, maybe I ought to get them straightened.
Alex: That’s funny.
Cindy: While the pandemic was tough for a lot of folks. As soon as the lockdown was ended, practices have all the precautions in place easily. Pure dental rebounded very quickly from the immediate shutdown. I think this being on screen is making people think about what can I do to change my [unintelligible 00:11:44]. Now all of a sudden you’re not going into an office, you’re not worried about your clothes, and you see yourself on screen and you say, oh, those are some things I can control and do some things about. That was a piece of it. The other part of it is, I think with DSOs and as practices become part of groups, we’re going to see the continuum of care that you see in other services.
Cindy: I don’t think a general dentist is going to become a perio specialist. We see that those practices, the doctor tends to have a skillset and stays with it. I think what you need to do is bring those different practices under your umbrella to be able to offer the services and have sister agreements and say, oh, we have the sister office. Why don’t you go here for your perio work, why don’t you go here for your orthodontics, those kind of things.
Alex: To make sure you have all those referral systems working, how did you support them? Is it marketing materials like a big part of dental revenue is patient retention and increasing share of care. Did you have marketing programs in place to say, hey listen, I love your GD business, have you thought about this, or did you know that we have this offer? Did you do anything for reactivations retention? We just brought someone on here in Cardinal so I’m looking to learn. How did you bring patients back in and educate them on the other surface y’all have?
Cindy: Yes, we have some software. The software I just finished using was not one of my favorites, so we won’t mention them by name but there’s basic tools that you can use for email marketing to your existing database. When we would have doctors who got new skill sets, what we saw a lot with general dentists tend to get certified to do Invisalign the non-metal braces straightening and that’s an easier thing. As you get new services, you do specific email pushes to the database to say, we’ve got this service available. Thinking that if you’re an existing patient of the practice and want to expand your work, you can get involved in those other things.
The other thing that you need to do is make sure your keywords focus on your services for the work that you’re doing. I’m preaching to the choir again when I say this to you, but the first thing everybody does, if they move to a new area or they’re unhappy with their dentist or they want to look for something, they pick up their phone and search ‘dentists near me’ or whatever, that gets punched in there. Just being relevant in that aspect. You can’t oversell your services, you can’t pretend to be good at something that’s not part of your score.
Alex: Yes, like trying to say the GD is going to be great at perio, you’re saying don’t do that. Maybe acquire a separate specialty and then cross-sell them together in the same area. It’s better than just saying Dr. Jim can do it all.
Cindy: Yes. The other thing is you separate your hygiene from your dentistry work. Then if you have hygienists that have incredible skill sets and know when you need a deep cleaning versus general cleaning, that’s really important to have because that’s when you go in and they measure and they look at your gum gaps and they do all the numbers. That’s how they can ascertain whether or not you need a deep cleaning. Those deep cleanings not only are good for the patient because it’s taken that stuff out of your mouth, there’s also revenue in it. That’s why they do the measurements.
You can’t be suggesting treatment for somebody with insurance they’re not going to get reimbursed for. It’s always doing the right thing and doing the right thing for the patient. Don’t forget about the hygiene side of the house in a dental practice because there are very specific things they can be doing in terms of the efficiency of their schedule and the depth of their skillset to see patients and take care of things.
Alex: I had never heard that before, so I just learned something new, I didn’t know the hygiene and they’re more likely to spot different things. They might say, “Okay, very cool.” Is email the best reactivation tool marketers have to bring patients back in? As a mass right now, is anything else useful?
Cindy: I would say that email’s stronger sometimes. What we tend to do when you’re onboarding a new doctor or you’re introducing a new doctor to a practice, then we’ll use direct mail to help let the community know you’re going to have a new doctor in the practice. It does two things. It’s not so much that I see it bring patients in the door kind of thing because you’ll do a mail or your have a call number, the mail houses can do the tracking, you can quantify how effective that piece is, but it does two things.
You create goodwill with your doctors that you’re willing to market them and support them, and you want to get them in front of the practice. It’s not that you do either or you do a direct mail piece, an email and a post, a whole suite of social campaigns to help some, a new doctor joint.
Alex: Okay, all right, I’m learning. That’s cool. How do you see the ADSO space? I went to the ADSO conference, but they wouldn’t let me sit in any of the panels because I’m a vendor, so that’s not fun. I haven’t gotten to hear how the ADSO space is going to be evolving in the coming years. Is it new technology, new strategies, is it more consolidation, less platforms from the ground up? You’re the space. It sounds like you get the business really well. Do you see any big changes coming up in 24?
Cindy: I haven’t been to a conference to see what the conferences are saying, but I’ve got some friends in the industry as well. Not just because we’re in the industry. Ironically, one of my colleagues from the post-acute healthcare space is now CEO of a private equity firm for DSO. They focus a little bit more on ortho and pediatric dentistry. The other DSO model that I’m seeing emerge is one that’s more, it’s not a membership, but the practices aren’t purchased. It’s an agreement to work with ADSO that it’s focused on EBITDA and production and improving margins and all those things. It’s really the getting ready to sell. It’s interesting–
Alex: It’s like rent to own or try the partnership before you buying it.
Cindy: Yes. It’s interesting because it’s in the DSO space, but if you contract and work with these other DSOs, you know that a sale to another entity is going to be inevitable. I think it’s preparing the doctor to be in a better position to reap the rewards of the business they’ve built in the eventual sale.
Alex: Getting them a feel for what the back office support can do for them.
Cindy: Yes. That’s a little bit more interesting to me, just because I know two groups that are doing it. There’s another group in Miami that’s similar to their model and they’re pushing to get to 200 practices where my former business associates practice is much smaller. I’m curious about it simply because that’s where marketing isn’t as easy to leverage as a backend support model, because the marketing support may be different for every practice. Personally, I struggle to get my arms around that a little bit more because I don’t know how you make those decisions. I guess it’s based on the structure of the deal.
Alex: We’ll find out maybe you’ll get to advise one of these one day. I’ll come to you if we get one. YI love that Cindy loves the business of dental as much as marketing and guys like that. That is something we often lose as marketers. It’s like we are just here to market to make sure patients find care. That’s actually not it. You have to love the business that you’re in. Why does it make money, how does it make money? How do we stand out and why are we better than the competing DSOs?
Learning and loving business is the quickest way to become a C-level because you’ll understand how marketing impacts it. That’s what every PE firm wants is marketing that impacts the top and bottom line. I think that’s cool how much you know about the dental industry, not just marketing. Anyways, that’s just side, I don’t see that all the time. It’s cool.
Cindy: No, thanks for that. I would say I give credit to the CEOs that I’ve workforce to do that. We focused on partnering with operations so that I know their headaches, not just coming to marketing to think they’re going to get a magic fix. It’s like when somebody says they need more.
score, it’s like what does that mean? What are you doing? What’s been done in the past? Why do you think this is going to work? When you have some technology in place, when you can look at that– One of the first things we looked at when I joined Pure Dental, I looked at our unanswered call rates and I had heart palpitations and I’m like–
Alex: I actually have AFib so I get that. [chuckles]
Cindy: We’re spending this money, the phone is not getting answered, what’s going on? Great. You go to the recordings, you read the transcripts and so then you figure out that there are robo-calls that are factored into that. Then we found a way to get the robo-calls factored out. The percentage went down, but my heart palpitations decreased a little bit. We still found problem areas and then you listen to calls and you’re like, oh come on.
Alex: I can’t believe we said that.
Cindy: We had a team meeting or a regional meeting and we played some of those, and every regional got to hear a disaster in each of their areas. It was so easy to say, “Hey guys we have some training we need to do. We need to work on how we want this to happen, because this is affecting the funnel,” kind of thing. The answer isn’t throwing more money at another marketing tactic, it’s what do you have as a tool that you can look at to see how are things working, and what might you–
People might say, why would marketing be involved in training? It’s because we need to have a better customer experience, from answering the phone, expect these questions, how are you doing it, pretend you’re smiling. Sounds like you really wanted the phone call to happen, not like they were bothering you by calling to see if they could change their appointment.
Alex: Exactly. Have technology to where they could do it online even.
Cindy: Yes, please. Again, post-pandemic, I think we’re seeing customers have less patience for things that don’t do well. They’re going to demand flexibility and they’re going to demand better customer service. Why can’t you book online? If you can connect the appointment request into your schedule, so it’s an actual true real thing, great. Some dental software you can’t see into the individual practice schedule level to say, oh yes that’s an open spot and it’s hot.
Alex: They’re smiling. They’re just going to go to a different practice. It drives me crazy and there’s plenty of good tools. NexHealth is one that specializes in dental and I think we’ve gotten them on some other clients, but there’s plenty of these things. You mentioned Chatmeter and a few others like no excuse for bad technology or a bad patient experience these days. Guys y’all heard us, Cindy will dive in not just into the marketing thing. Let’s not just fill the funnel, let’s convert patients all the way through and make sure we bring them back in.
As marketers, our job is to drive revenue not leads, revenue not leads. The revenue can come from that new, but it also can come from converting more of the net new, it also can come from bringing back the existing’s for more care. Let’s look at the whole continuum, let’s care about the business. If you don’t know what the business result is, start there. Meet with the C levels and your boss and say what do we really care about? I can get seoPBC that’s the easy part. What are we really trying to do? That’s where Cindy starts. She’s got an MBA, she’s fancy, she gets how to do the business right.
Cindy, I could go on forever. Usually, these are 12 minutes. We’ve gone almost half an hour, so I appreciate it. We’ve got a great conference coming up later this year called Scaling Up just for performance marketers and healthcare, so I’d love to invite you to that. Potentially you could speak and help us out. I’d love the business side that you understand. We have a dental panel too so we’ll talk later.
Thank you Cindy for joining us on The IGNITE, this will be cool. We’re going to promote to the country every DSO marketer, every healthcare marketer needs to hear how much you care about the business. Thank you.
Cindy: Thank you. It’s been a lot of fun.[music]
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