How Marketing Drives Portco Growth with H.I.G. Capital

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? Special episode. Y’all told us through your attendance and the reviews afterwards of Scaling Up that y’all’s favorite session was our private equity session, which is funny for a healthcare marketing conference, but you guys made it clear that all of us healthcare marketers, what we really want to understand is how the private equity group looks at us, what makes us successful. At the end of the day, we want to drive the business result, and nobody knows it better than the private equity marketers themselves. Anna, welcome to Ignite. How you doing?

Anna Carlsmith: Good. Thank you for having me.

Alex: No worries. Tell everybody a little bit about yourself. Where do you hail from? Where do you work?

Anna: I work at HIG Capital. We’re a middle market private equity firm with $67 billion in assets under management. I’m a marketer by trade. I was recruited by HIG to serve as an in-house consultant. I’m what’s called an operating partner. You’ll hear that term across private equity. It essentially just means that we’re people who offer resources, basically serve as an advisory role to our portfolio companies.

There’s both generalist operating partners and function-specific operating partners. I’m a marketing and go-to-market operating partner. You’ll see finance operating partners, tech operating partners, et cetera. We essentially just serve as in-house consults for our portfolio companies. I’m fairly industry agnostic, but I’ve been spending most of my time recently with our healthcare portfolio companies.

Alex: Is it your favorite? Do you love–

Anna: It’s now. Yes. I’ve gotten pretty into it.

Alex: It’s so cool. We fell into it too, but when we were figuring out our hedgehog for where we wanted to plant our flag as Cardinal, I was like, man, nothing feels better. We get to use our marketing superpower for good. These are lives you’re changing, and if we’re not selling more pizzas online. It’s a good feeling. HIG Capital has a variety of different healthcare services, PT, derm.

Anna: GI, vision, dental.

Alex: A lot of low-acuity retail type stuff was bought online to give people a little bit of an idea of Anna’s background. Specifically, Anna, when you are looking at a for cause marketing function, what are you hoping to see? What does success look like? What are those building blocks you’re like, we can build from here.

Anna: At the basis of success for a marketing team is always the reporting and measurement framework. This is something that I think healthcare in general is behind on largely because the industry is more focused on care delivery and other operational challenges, but also HIPAA compliance gets in the way of simple tracking that e-commerce and SaaS can use.

The first thing I want to see is full funnel tracking that’s both HIPAA compliant and ultimately tying every marketing dollar back to revenue generated from patients. Ideally, a patient file in the EMR is being appended with the original marketing source. That’s a lot easier said than done, but that’s what a very solid marketing team– If I see a marketing team that’s doing that, I know they’re in the top 95th or more percentile of middle market healthcare companies.

Alex: They’re acing the ACT. They’re going to Harvard if they can do that. That’s awesome. What systems have you seen? Those top five-percenters, what have you seen them implement that’s worked really well? How are they? They have integrations with EMRs. Give a high level of where you’ve seen that practically implemented. How do they do it?

Anna: It’s usually something like a patient prism or a line that’s integrated with the EMR, or sometimes there’s a CRM sitting between the call tracking and the EMR. It’s going to be different. There’s all these different specialty-specific EMRs, so it can really vary quite a bit, which also just adds to the complexity of the industry. Marketing integrations are usually the last things that the EMRs want to set up. It’s usually like the call tracking CRM to EMR or it’s just call tracking to EMR if we’re lucky.

Alex: It’s wild how many groups come to us and they don’t even have the lead track and call and email tracking. You mentioned line and patient prism, two of our sponsors from Scaling Up and two of our good friends. One’s my neighbor and the other one’s a good buddy. That’s basic stuff, and a lot of provider groups don’t even have that set up so they don’t even know how many phone calls, leads, emails. A lot of that stuff, guys, for those three listeners we have out there, they do more than that. They function somewhat as a CRM as well at times, and things like this is one little nuance they both have in their back pocket.

Yes, they’re input compliant, they’ll sign BAAs. When an email form comes in, we know most provider groups never respond to them. I don’t know why. The call centers are allergic to them. A line and patient prism, if you have it enabled, will actually call the patient and the call center at the same time jointly and so they connect them and those email forms don’t get dropped off. You’re talking about something that not only tracks better, but it also helps your conversion so you don’t need as much ad spend for the same amount of leads.

That’s cool, Anna. You’re talking about the function and the measurement. At the end of the day, what you need is the business result and you need to understand how much of the advertising drove that and what our return is. What do you look at, when you look at the work structure of the marketing function, what structure have you seen work best, the in-house, the out-of-house, all of that stuff? What do you look for there?

Anna: It really varies on the size of the company. A much smaller healthcare company is not going to be able to support a large marketing organization. I always encourage our portfolio companies to be strategic with the use of outside resources versus just trying to hire for every single function in-house. It’s almost better to just find people that know the specialty and know the industry really, really well, and then use expert outside resources in some cases.

I think for bigger companies, you have people that have the marketing and digital side and the healthcare side, but for lower-middle market, that can be challenging. It’s just the case of networking into the right agencies, the right tech partners, and letting them manage the marketing and digital piece, and then focusing on applying it to the specific business.

Alex: Lower-middle market. What do you think the first hire is? Is it someone that has digital experience, especially for these retail-y type healthcare provider groups? People ask me all the time. I’m like, I think you want digital, but I might be biased. I don’t know.

Anna: Yes, I think you do. A lot of it is demand captured these days with like paid search and SEO and just making sure that you’re there when someone is searching for the services. It really varies, though. If it’s a more retail service, there’s got to be a higher volume of searches versus if it’s a more– if it’s GI or another specialty, it’s going to be largely referral based. If it’s referral based, you almost want someone that understands that can work with like a patient liaison team or a physician liaison team and that can do more provider marketing.

If it’s more like retail, then you’re looking at someone with the digital growth experience. What I’d want in a first hire is basically just someone that can own the patient journey, like the inbound patient journey, all the way to onboarding. They understand the basics of digital media, campaigns, SEO, website optimization, call tracking. From there, then it goes into patient onboarding, which is typically owned by operations, someone on the operations side. I want them to be really thinking of every touchpoint up until that person becomes my new patient.

Alex: You’re saying that you don’t want a marketer just focused on getting the lead and going back to work. You want them to think about is the call center converting? Do we have capacity? All that fun stuff.

Anna: Exactly.

Alex: We call it MOps. Marketing and ops alignment. A friend gave me that one time. Yes, Teresa. She’s at PRM. She’s really sharp. How would you suggest marketers get that knowledge? They don’t need to? Do they need to come to you with an MBA? Do they need a strong CEO they become buddies with? How do they get to the business result needed and track it all the way through without stepping on people’s toes?

Anna: How they learn how to be marketers or–

Alex: How do they measure the business result? Usually there’s going to be an operations leader that’s over call center and stuff and may not want anybody stepping on their toes and things like that. Have you seen successful marketers? Do you have any practical advice? Hey, listen, go be buddies with them or go get your MBA, or get this dashboard set up in this way.

Anna: I don’t know that MBAs in healthcare are going to be for a marketer in healthcare. You’re probably not going to learn it in your MBA program. You’re probably just going to learn it by doing having an MHA. A master’s in health administration might be more valuable. Again, for marketing, so much of it changes so rapidly that the stuff you learned your first year would be obsolete by the time you graduated. To have the respect of the team, I think you just have to center the patient care and the care delivery and show that that’s your primary focus. Then I think the relationships with the head of operations, whoever else, will follow.

Alex: All of those Ocon. That’s what we’ve been preaching, guys. We can’t just be marketers for marketing sake and drive more leads and then walk away from it. Nobody cares. CEO and the private equity, team doesn’t care about that. They want the business result and how much revenue is generated. Oh, I want to talk about marketing for a second. You’re deeply embedded and you see we talk about demand capture. Google’s losing markets here slowly. How long do you think we’ve got on the PPC drug and where are you seeing the most sophisticated provider groups starting to change their marketing? Are they going into different channels and funnels? What are you seeing them do differently?

Anna: I think there’s going to be an increased focus on the patient liaison or physician liaison team, so people who are partnering with referrers, having a strong team there. That’s something that sits in between marketing and operations. It’s not always clear who owns that team. It will just depend on the company. I think that will be an increased area of investment in terms of headcount and also marketing resources, sales collateral, that kind of thing.

Otherwise, it does seem like some brands are building up organic social presences. I don’t know that I’ve ever seen that as a huge lead gen source, but it’s almost more of a branding piece. Then there’s just the point too of as we start to learn what works for ChatGPT SEO, staying on top of that as the AI search and just steal share from Google.

Alex: It’s coming.

Anna: I think we’re in our infancy there. That’s relatively new still.

Alex: My wife is sitting on the couch all the time and she just has ChatGPT like, hey, give me a dermatologist. I’m like, “You don’t want to go to Google and then search through 10 links to find the best ones?” She’s like, “No. I want the answer.” I’m like, wow. I think a lot of people are going to start doing that. Then the next night she’ll be on TikTok and she’ll start getting served ads for the cool dermatologist down the street. I’m like, wow, this is really changing. Google is losing market share and my wife might be one of the first adopters. How long of a runway do you have? I don’t know.

Anna: A huge percentage of people are already using ChatGPT as a search engine. I don’t know the stat off my head, but it’s high. it’ My prediction is that eventually they’ll introduce ads in the platform as everyone does, so then it will just become we’ll just have to manage two different paid search accounts.

Alex: It’s going to become the same thing, because at the end of the day, ChatGPT is just surfing the web. When it’s not just surfing the web anymore, what’s it going to give, the same dermatologist over and over to everyone, and they’re going to get flooded with 1 million people in Atlanta? Advertising will be introduced and TikTok is very– You seeing any porkers using TikTok advertising successfully or any of them doing anything there?

Anna: Yes, but more on the consumer side typically.

Alex: Very cool.

Anna: I don’t know. Have you guys used any of your campaigns [crosstalk]

Alex: Yes, we’re rolling out campaigns. Yes, we are. We brought over a few people just on board as three paid social specialists with TikTok experience because we’re getting asked more and more. A lot of provider groups are still a bit antiquated. They’re still hooked on the run PPC, more PPC drug and more SEO. We know the patient journey is changing and she’s getting information from a lot of different places.

We have been pushing our clients, but they’re starting to dabble in Meta. That is healthcare so far behind. Healthcare is now starting to dabble quite a bit in Meta, and we’ll see TikToks in a few years. We’re starting to get into it. The algorithm is better than Meta. You have to let the algorithm run, is what we have found. The less optimizations, the better. The Chinese have us better figured out than we do.

Anna: It doesn’t help that we’re just telling TikTok exactly what we like versus Meta is just basically guessing at it based off of hover time, which is harder. It’s interesting. Do you find that Meta is working well for smaller healthcare companies or is it bigger, more retail healthcare?

Alex: Yes, bigger retail healthcare. At some point, our groups will run out of capture and there’s no more efficient PPC spend out there, but those are the ones with hundreds of locations that are spending $1,500 per location and it’s just not getting efficient. You’ve gone and captured all of the fish that are already looking in the sea and now we have to go make more people aware and all that stuff, so we’ll start going up our funnel. That’s why we built our own modeling system. We call it WebRx. No, Anna did not come on here as a plant to ask me that, to lead me into this.

I promise. That’s why we have our own modern solution because it came out of necessity. We had too many clients reaching the point of saturation. We said, we don’t know where your next best dollar should be spent, so we engineered a model that uses investment modeling combined with our healthcare routines we take in capacity, blah, blah, blah. We spit out, listen, whether it’s making Meta, TikTok, billboards, linear TV, or digital, this is where your next best dollar could be spent, marginal ROI, if you will. The bigger groups are utilizing that. Now, most groups under 100 locations can spend more on PPC and they don’t.

That’s still where they’re at. We are trying to educate them to start getting out of the PPC thing, because that alone will not work in three years. It’s my opinion. We’ll see. The problem with a lot of the demand generation stuff with programmatic and Meta, and TikTok is it requires much better creative, and that’s another investment. They don’t know if they want to do that. That’s tricky. You have big groups, Anna, at HIG. Do you see any of them in-house creative? Do they have an in-house creative designer? Do they use agencies for everything? Is it not a major function?

Anna: Really varies by company, just depending on who’s in-house. Then some of them will use ChatGP– obviously use AI to help edit creative, things like that. That really just varies depending on the size of the team. It’s not really a standard answer.

Alex: I find it interesting that you, I’m reading between the tea leaves, but it sounds like you prefer small in-house team and then use agencies, or contractors or whatever. Why does PE believe that? Because it scales faster. Hey, we need to sell this in three to five years for triple. We don’t have time for you to build the in-house empire. Why is that the theory at PE?

Anna: It enables you to use a point solution, like best-in-class for each individual function, which is always better, obviously, if you can, if you can afford it and if you can manage it. Then it also just creates more nimble teams, if you’re always just adding headcount that creates organizational complexity, organizational challenges. Relying on agencies just gives you more flexibility to scale up, scale down as needed.

Alex: I love it. Smarter and faster, guys. That’s the headline of this. That ended up being a promotional tool. I love it. Oh, I have only two more questions and we’ll get you out of here. Regulations around HIPAA compliance and full funnel tracking. I know you’re very keen on that and understand the return. What is your view on how compliance will change? We’re going into 2025, guys, to timestamp this. Are your porkers generally as concerned as we were a few years, or we have the pixel, we don’t care anymore, or we’re still very safe or we’re starting to push boundaries again? How do you view that?

Anna: I think this is one of those areas where marketers just need to know their own limits. This is just an area where I try to stay close to legal on versus just, wait, having a marketing team wing it. This is like in the intersection of marketing tech and legal, but ultimately it’s more of a legal question. I just advise marketing teams to stay very close versus interpreting it themselves essentially.

Alex: No more self-interpretation. Oh my gosh, Anna, we meet with groups that are like, we’ve got the pixel on. Other groups are like, no, don’t even put that. We have a CDP and we’re not going to touch anything. You’ve got the whole spectrum there. We’ll see what happens in the next year. Final question I’ve got for you. What is one marketing strategy or tactic you’re really excited about going into ’25 you think should be invested in more? Doesn’t need to be newfangled, could just be the same old stuff that works well. Up to you, but what is something you’re excited about next year?

Anna: I think it’s just going to be more content marketing. I think as Google is just returning, and AI is just returning so many of the answers already, you want to be featured in the source there. There’s just an opportunity to grow your domain rank and your domain authority so that when someone is really searching with the intent of booking, you’re on the top page. Obviously you’ll never compete with the big medical publishers, but I think there’s a local strategy there, putting the right keywords on specific local pages. I see more and more companies doing that. We see big gains with that.

Alex: Unique and differentiated content to cut through the AI ocean of sameness.

Anna: That cut through the ocean of sameness, but also because there is so much more content coming out of AI, if you aren’t using that, you’ll be left behind. Almost like keeping up with the ocean of content coming out of AI is important too.

Alex: So wild. It’s like, we need our own ocean, but it’s got to be a better ocean. Yes, it’s tricky. We’re in a weird new world. The cool thing, Anna, with marketing and being marketers is that there’s a ton of job security because this thing changes, in healthcare, every six months. It is very cool. This thing is changing a lot. Marketers, Anna, where can they find you?

Anna: Where can they find me?

Alex: LinkedIn? Are you pretty–

Anna: I guess, yes. I don’t have a big presence on Twitter or anything like that. Yes, LinkedIn. Find me on LinkedIn.

Alex: Find her on LinkedIn, guys. She’s absolutely brilliant. Our team can attest. I think our team’s pretty sharp. Lauren, chief crowd officer, said that Anna’s super sharp, you need to have her on Ignite. This did not disappoint. I had a ton of fun. It’s always fun for marketers. It’s a good reminder for me what actually matters at the end of the day. It’s not more rankings. It’s not more clicks. It’s not more leads. It’s the business result and growing this, and connecting more patients with care. Anna, thank you for joining us on Ignite. This has been an awesome time.

Anna: Thank you so much for having me.

Announcer: Thanks for listening to this episode of Ignite. Interested in keeping up with the latest trends in healthcare marketing? Subscribe to our podcast and leave a rating and review. For more healthcare marketing tips, visit our blog at CardinalDigitalMarketing.com.