Scaling Orthopedic Growth One Patient Experience at a Time

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Alex: All right, guys. This is going to be a blast. Today, we’re going to have a really nice conversation. We’ve got a superstar with us, and we’re going to be able to talk about low acuity procedures, high acuity surgeries. This is going to be really cool because it’s a really big group. It’s a treatment site, a provider group type that I’m really fond of because it’s helped me recover in some things that I have. Daniel, it’s nice to say you’re an athlete. I’m not an athlete, I’m a marketing nerd, and that’s why I’ve torn all of my ligaments. Daniel, welcome to Ignite.

Daniel: Thank you so much for having me. It’s a pleasure to be here. As an avid listener, I’m honored to be part of the show.

Alex: Hey guys, we found one of our foreign listeners. I knew one day it would happen. I knew one day it would happen. This is fun, and it’s cool because on our email forum for Cardinal, people say how they found us, and more and more it’s the podcast. I guess a lot of people are listening to it. I don’t know if it’s just our LinkedIn bereavement, but it’s cool and I think that, I mean I don’t think, this is how I learn the most because you’re not a client and I get to just ask freely questions that I’d be afraid to ask clients so I get to learn a lot from you. Daniel, where are you based? I know you’re in Atlanta right now. Where are you based? Where do you work?

Daniel: Day to day, I’m working out of my home in Phoenix remotely, but UMP, United Musculoskeletal Partners, has practices in Atlanta, Denver, and Dallas so I’m traveling a lot between Atlanta, Denver, and Dallas, but I’m not at home in Phoenix.

Alex: Which one’s your favorite city?

Daniel: Atlanta.

Alex: Yay. 18 million. He’s going to come to the darkside soon, guys. We’re going to pull him over here. Atlanta’s a beautiful, great place to grow a family, make money, et cetera, and tons of healthcare. What is UMP exactly? Let’s start with that. Let’s frame up the size, and then we’ll talk a little bit more about what you guys do.

Daniel: UMP is United Musculoskeletal Partners. It’s an orthopedic MSO comprising about 250 physicians, 10 physician practices in three states, with about 50 locations. The biggest partner that everyone’s mostly aware of, the orthopedic space, is Resurgens Orthopaedics, about 110 physicians. They’re the largest group, but in Denver and Colorado, there’s probably another 100 or 110 physicians between those groups as well.

Alex: Yes, so it’s big, big, big time. I know Resurgens. I mean, y’all have had tons of billboards around Atlanta for so many years, and it seems like the value prop is biggest. I always see [unintelligible 00:02:26] muscle orthopedic surgeons [unintelligible 00:02:28] that seems the value, or at least it was five years ago when I was living in the city. I don’t know what the value– We’ll talk value props and go to market and all that stuff in a little bit. What is your internal team? I mean, this is a huge group. What does your internal team look like? You have 100 people doing marketing in-house?

Daniel: No. It’s funny. I started here in May. Prior to that, I was with another large orthopedic MSO, HOPCo, but I started here in May of 2024. The team was relatively small. There was a VP of digital marketing, there were two or three marketing specialists, generalists on the team. I built out that team to include more resources, so graph design, content creation, more of on our web analytics and the paid media strategy. Right now, it’s about nine.

Alex: Nine, but still, yes. You’ve got a ton of stuff in-house. I get this question a lot. What do you think the first hire should be outside of Daniel that’s going to coordinate all the stuff and the strategy? What is the first in-house hire a smaller group should go for?

Daniel: For a skint in-house hire, it should be someone who’s familiar, whether it’s PPC, paid media, SEO, whatever it is, someone who is digital first. We, as an organization, all the things that I mentioned, those are in-apps. The one thing that we continue to outsource is SEO. The reason is because, as you know, it takes a large team of people to provide valuable SEO. I have to hire 10 people to do the work that Cardinal does. From a cost perspective, it’s better for me to outsource SEO but keep certain things in-house to control costs.

Alex: Absolutely. A ton of content and all that stuff, and then getting the agency to also coordinate with your MD so that the content’s not ChatGPT garbage is like getting the name of the game in SEO. Guys, if you want to see a really good SEO site on whoever the agency is, they deserve a shout out because I went to the Resurgens site and I clicked on the location pages. I love it.

We got CTAs for scheduling appointments. Seems to go out to radics, and we’ll talk about tracking in a little bit, but then you have an auto population. I guess it’s an iframe in of reviews that are coming in all the time. You knwo they’re not doctored or maybe this is something smart that’s only bringing four or five– so no, it’s not, right? Is it a burn eye of [unintelligible 00:04:22] and it’s framed in? How is that happening?

Daniel: The partner UMP chose was Socially Inclined. They use Socially Inclined for their reviews. We do a little bit differently. The external reviews that you see that get on the website on GMVS and their review sites, that’s what a lot of it’s for. What we speak it for too was we wanted to know on a patient experience side how their experience was with not just their provider. How was scheduling, checkout, the MA, all the stuff that goes into what makes the patient experience, there’s questions around that too, because we know that you’ve seen 100 reviews where it’s Dr. Jones was great, my favorite doctor in the world, three and a half stars. Three and a half stars is because Betty at the front desk was mean to the person, or they waited too long on the phone, but the review is representative of the physician. We wanted to correct the internal issues that denigrate the patient experience so they have a five star experience, not just with the provider, but with the entire organization.

Alex: Betty at the front desk.

Daniel: Three o’clock on Thursday, she’s checked out, she’s had it.

Alex: I don’t blame her, man. Dealing with all the nonsense that comes in there, and sometimes you don’t have a centralized call center, so you also have all of the existings calling back saying, “Why wasn’t my script billed?” Or, “You’re double-billing me.” Betty’s got a tough job, and that is, Daniel’s spot on, guys. The bad reviews for all the provider groups we see come in at Cardinal, at least before they started working with us, they’re always front desk related, billing, blah, blah, blah, blah. It’s almost never the providers, because–

Daniel: The providers work really hard to be smart and give good care. As you know, when you have a client that’s coming from another agency to your agency, there’s a lot of behind-the-scenes light work to just get ramped up to understanding how they structure things, understanding their strategy, understanding how they gauge results. When you take up a new partner, there’s a lot of behind-the-scenes work that goes into it for you to say, “Okay, here’s where you are, here’s what we need to get you.”

Alex: Yes, I love it. Also, a good point that your agency can’t do it all for you. It is a collaboration, and that is one of the biggest pitfalls I see with agency partnerships is Cardinal, whomever is brought on and think they can do all the work and we can only move as quickly as you guys can. The focus has to be there and doing the right things at the right time, not all of this. For stuff, I’ve seen that be a big gap. All right. This year you got a huge group, it’s 2025, what are you most focused on with your team?

Daniel: Growth. In the healthcare space, in general, the focus is always growth. That’s growth in new patients, that’s growth in everything. Downstream, and we see new patients, not just the new patient growth, we want to see that patient for DME imaging, all the downstream things that happen in the continuum of care, and making sure, as best we can, our patients stay within our practice for that continuity of care so their care is not disjointed and frankly so that they’re not paying for services that could be rendered somewhere else or are rendered twice because the communication between our practices and an outside provider isn’t happening and that costs the patient more money.

Alex: I love it. Increasing lifetime value and making sure they stay in the system. Also, something I’ve noticed the health system not so good at. When I tore my ACL, I got it done– I won’t name the Atlanta Hospital because I love them, I had a kid there.

Daniel: I can guess. Go ahead. [chuckles]

Alex: I had the image done, said torn ACL, and no one called me to do surgery, left $25,000. It always blew my mind. All right, we’ll talk journeys for a second. Do you put people, patients into certain segments? Do you have CRM? Do you have an automation tool? Talk about that. Does an ACL person get ACL? Does an imaging get imaging content? What do we have going there?

Daniel: We have first-party data from our EMR that segments patients by ICD or CBT code. That gets extracted every few months. There’s points in time where patients, let’s say, stop receiving care because it’s not necessary right at the moment. When you tore your ACL, I don’t know if you partially tore or fully tore it. If you fully tore your ACL, you would have trouble ambulating day to day and walk. You have to have that surgery done. There’s a patient somewhere with a rotator cuff tear or shoulder arthritis that has episodes of pain, but then they go away, or the activity modified, and they say, “I’m fine. I can deal with it.” Those patients need a little bit of reinforcement and re-engagement with the content you’re talking about around innovations and treatment options for their specific injury, new advancements in treatment for their specific injury, as a gentle reminder that this is something that may not be problematic now but probably flares up every so often and there are solutions for it.

Alex: I love it. They’re going into a different one. I got you. Out of EMR, you’re pulling out the different diagnosis codes, and then they go to different– What do you use for the email outbound? Are you using–

Daniel: Cloud.

Alex: Marketing cloud. I got it. All right. Salesforce is awesome, but you need a serious person dedicated to in-house or become shelfware. I’ve seen that time and time. Do you have marketing? Especially, who is doing that? How does that get done?

Daniel: Our VP of digital has led the Salesforce process with some of the people that Salesforce provides to you, but Richard, who’s our VP of digital, has led from start to finish the entire build out of the environments of the scale of everything. That is a lot of his expertise.

Alex: Man, Richard, shout out. It’s not easy, man. You know it’s tough because it’s not just like making sure the right people are getting the right message, but what is the message? It takes a creativity of a content person, along with a marketing ops A-type person.

Daniel: Absolutely.

Alex: It’s tough, but yes, lifetime value, hugely important. All right. Well, let’s talk acquisition then. How do we first get them in the door? Imaging, do you try to get the imaging clients? Is that where media’s going so that you try to get all the tears? Or do you just straight advertise for orthopedic surgeon near me?

Daniel: We’re looking at behaviors. We find the lookalike audiences, we use our first-party data. We’re looking at behaviors, and not just the behaviors that you typically had where it was health and fitness, or it was active lifestyle. Well, on social media, that was the sort of buckets they gave you. We’re using some AI tools to match patient behaviors with our first-party data, so we know who was more likely to be injured or who’s likely to be presently injured, and then giving them proactive messaging, whether that’s through OTT advertising, social advertising, display, whatever the channel is, because we know they’re further down the funnel than the average person is.

I think about it too. There’s always that patient who, after two or three months, wakes up and says, “I have to do something about my knee pain,” goes right to Google, and types in Best Knee Doctor Atlanta. For search purposes and SEO purposes, whatever your preference is, you still want to be at the top of that search because they’ve made an instantaneous decision to get care now. They don’t want to wait any longer than they already have. You need to be present in the top of the search to capture them.

Alex: I love it. Guys, that’s full funnel advertising. Top of mind. All right. Let’s talk first about, again, the bottom of the funnel, that’s Cardinal’s bread and butter, making sure we show up for. It’s interesting. Are you bidding on knee pain instead of you’re bidding on [unintelligible 00:10:45]

Daniel: Yes. It’s strange. I’ve done this for 15 years. The phrase knee pain without what we call provider modifier, like the word doctor, specialist, you’re going to get a lot of research-based terms. For those who are in orthopedics, the phrase back pain, one of the most commonly searched terms there is. The conversion from the phrase back pain to an appointment, it is incredibly low. If you add the word doctor or specialist, the conversion rate is high. It’s those modifiers that you need to be aware of to understand the person’s intent versus just them doing research.

Alex: Rank for symptom without doctor bid on symptom plus doctor.

Daniel: Precisely.

Alex: Daniel’s giving specific tips, guys. Finally, we’re getting it on Ignite. I love it. Let’s talk about the full funnel advertising. You said you’re using AI tools. Are you buying third-party data? Are you buying diagnosis from other things or [crosstalk]

Daniel: OTC platform, they have data from Process, PurpleLab, and some of the other third-party data sources that they can bring in to us. We run that against our lookalike audiences to see what performance match. Within, let’s say, an OTC campaign, there’s two campaigns. There’s the one using the third-party data from those vendors, and there’s the one using our AI model, the AI first-party data. We want to see what performs better, but doesn’t perform better necessarily in terms of impressions. We want to see what performs better in terms of conversions.

Alex: How are you measuring conversions if those are upper funnels? Is RADx allowing you to see [crosstalk]

Daniel: Certainly, we don’t. We don’t see what occurs inside the appointment-making functionality. We measure the conversion as they click the schedule. That’s the conversion. Then, in some instances, we could trigger another conversion on a thank you page, because once they exit the platform and they’re out of the iframe where all that information is PHI that we don’t capture, they’re brought back to a thank you page and we can say, “Okay, they completed the form.”

Alex: I love it. I love it, man. You’re tracking this end-to-end then. That’s pretty good. PPC, you definitely know. Yes. Great, great, great. That’s very smart, guys. They’re even separating out the audience’s third-party versus their own AI model. Those upper funnel channels require great creative. You have the creative strategist in-house too that’s turning out things in different ad types and segmenting.

Daniel: They both [unintelligible 00:12:50] collaborates. I’m creative. I’ve done ad creative for 15 years. My belief is always that if given the opportunity, having a patient tell their own story as opposed to the commercial, which is like the B-roll, the slow-motion doctors walking down the hallway, the voiceover interaction. That’s valuable if your budget is limited, but if you have some budget to use, let patients tell their story because what patients want, it goes back to your point about reviews is when a patient’s looking for a provider, looking to see who they should see for pain or injury, they’re looking at reviews because they want the shared experience of somebody else, and that’s what they are looking for.

If it were through a video advertising, mostly reviews, social, they want to hear people who look, sound, feel like them, tell their story, talk about the challenges, and talk about how your practice helped them overcome that challenge. I want someone else to tell me how great this doctor is. I don’t want to hear the doctor tell me how great he is.

Alex: That’s right. That’s right. Patient testimonials, number one. Do you have a pragmatic every quarter someone is scheduling? Those are asking providers, “Hey, did Cindy like you,” or give me three? It is half an hour regular basis.

Daniel: We tell doctors, “Look, if you have an interesting patient, patient with an interesting story, let us know. We’ll reach out.” Then we just look at reviews and say, this patient gave you five-star reviews. It’s on the platform. This patient said my surgery turned out great. We’ll then work with the practice to coordinate, to reach out to that patient because we know they’ve had a positive experience.

Alex: Someone is paying attention to all of that. I love it. Patient acquisition masters. I’ve reached out to Resurgens a hundred times the last 16 years. This is why they didn’t call me back, guys, they haven’t figured it out. That’s very interesting. That makes a ton of sense. You can’t use patient testimonials for every type of ad type. Right? Do you have awareness, different things, or that is the awareness? Then do you have a final conversion resurgence, bigger, better outcomes than anybody else? Just click the appointment.

Daniel: Yes. It’s just do it. It’s like, “Come on. We’ve been waiting for three months. Let’s go now.” What we focus on is in the upper funnel ads and the upper funnel models, whether it’s display or OTC, we focus on access. We’ll see you within 24, 48 hours, same day, next day appointments because [unintelligible 00:14:56] earlier. You went to a large health system for your knee surgery. After your imaging, you probably wait a few days, a few weeks to be seen by the orthopedic surgeon, if at all. People who are in pain don’t want to wait that long.

We focus on access. The top of funnel is all about access. Downstream, it’s about the specific provider at a specific location, but I want them to find the instance of Resurgens or in Denver panorama. I want them to be aware of the access and excellence around panorama, and then once they’re further downstream, then I want them to start researching, should I go to this provider or that provider? The choice is always between two in the same practice, not two at an outside practice, because of the brand awareness we’ve generated through those top funnel campaigns.

Alex: Got it. All about access, then all about the provider access around there. I love it, guys. That makes a ton of sense, Daniel. I think I get your whole conversion philosophy. I think I get your tracking for the most part, and that’s pretty cool. It’s enabling you to pixel, kind of pixel, at least know what’s going on on the thank you page. Really advanced advertising stuff. Someone watching performance creative, guys, the whole point is that it converts. They are not just creating stuff in a vacuum. They’re even testing audiences against each other.

This is possible. Is it possible? If you have a team less than nine, yes. If you’re smaller, go to an agency, and you may need multiple agencies, somebody that does creative, blah, blah, blah. It is very important. This is what Cardinal’s been preaching for years, and Daniel, [unintelligible 00:16:17] so very cool. Is there a topic in healthcare marketing that you think deserves more attention that is just itching at you like, “Ah, no one’s talking about this enough?”

Daniel: Yes. It’s the example I always give of if the job of the marketing agency or the marketing team internally is to make the phone ring, make sure there’s enough people to answer the phone. It’s always this thing of bringing more, bringing more, bringing more, but then they’re not being converted because they’re waiting six minutes on hold, or no one’s calling them back when they’ve been referred, or no one’s doing a follow-up. It’s like, if you know even the annual value of a new patient to your practice, you should know when you don’t answer the phone and they go somewhere else, not only did you not make that revenue, you lost that revenue because it was ready to be handed to you. You lost it. We work very closely with our operations team on all times, abandonment rates, conversions, all that stuff. I trained our contact center people.

Alex: Really?

Daniel: Yes, because what’s–

Alex: Isn’t that the head of ops job?

Daniel: It is, but it’s something I’ve always done and I enjoy doing. The reason I do it is because, look, the call center person’s job is very thankless and very monotonous, so I understand. The first thing is this. I always tell them, the people in contact center, “You are probably the first person in health care this patient has talked to ever. They are scared. They are nervous. They have a hundred questions, but you are the first person they’re ever going to meet. You make the impact.”

There’s little things, just simple things, addressing the person by name, giving them options, helping them direct their care, and creating a one-on-one relationship with them so they feel more comfortable, not only with you, but with the entire practice. It goes back to that talk about with reviews. It starts at check it. Well, this is check it. The whole experience needs to be five stars, not just provide it. The contact center person needs to be five-star. The insurance verification, the pre-authorization, all that stuff needs to be standardized to the patient’s best experience.

That is an operations function, but it bleeds over into marketing because you or I would say, “We’re getting all these new leads and conversions. Our new patient numbers aren’t going up.” It’s because of the second half of the journey.

Alex: You heard it, guys. If you’re not reporting on the actual ROI driven, then I think the C-suite is less giving a budget the following year. You heard it, yes, it could be an ops function, but if they don’t convert all the leads, then you get no more budget, and you get blamed when patient flow is not where it is. Guys, we talk about [unintelligible 00:18:33] all the time, marketing, and ops alignment. This is what it is, sending ads to where there actually is capacity, and then making sure people are picking on the phone.

Everybody, go call your contact center. I think, Daniel, yes, very thankless job and tough job. For them to be able to educate, I called into a good contact center for a procedure the other day, and the woman knew the treatments and the different things they treated, routed me to the one office and the one provider in Georgia that could do it. That takes a ton of training. You can’t get someone off this train. Cindy, good luck tomorrow. Just pick up the phone and schedule people with something high acuity, like you guys do. Yes, lots of training. Daniel was a salesperson in his prior life. He must have been to one of the contact centers.

Daniel: I hate to admit it, but having run an agency for nine years, eight years ago, part of my job was sales. I just never admitted it. Yes, there’s some element of that.

Alex: Everyone is selling. Marketing is selling. It’s marketing. It’s just the first part of selling, which is getting them in the door and then you don’t sell them all the way through. Guys, health care, I know we don’t like saying sales. It’s supposedly a dirty word, but we are here to sell, no margin, no mission. We don’t get patients in the door they find care somewhere else that is not as good. Bad outcome. Everybody is sad after that.

Daniel: Absolutely.

Alex: Daniel, what are you focused on most this year, innovation-wise wise or something very different? I’ll leave you with this one last question. Is there anything you’re paying attention to that’s like tip of the spear, or?

Daniel: Yes. This is going to sound funny, but I’m very focused on the proliferation of value-based care in the health care space. What patients, what providers are more focused on now, so cost and outcomes and the things that aren’t necessarily tangible or visible to patients but are visible to referring providers, payers. Those things we say, look, we can do the surgery for better, cheaper, with better outcomes. That is where healthcare is going in the future, so we’re trying to stay ahead of that by measuring outcomes, measuring quality, measuring cost, so we can be ahead of the curve. It’s not a very digitally-focused thing or acquisition-focused thing, but it’s a future-focused thing.

Alex: It’s a future-focused thing, and if anybody ever wants to be a CMO, you have to know those. You have to understand the business that you’re in, that will be. That is the ultimate job, and that’s what Daniel’s learning on. It’s like how you get your MBA. Yes, and at the end of the day, outcomes matter, and whether for marketing, we need to know that specifically, no, maybe, not right now, but certainly measuring the outcomes is a USP in our marketing stuff, so that’s awesome, and I like that things are moving to value-based care, albeit very slowly.

Daniel: Very slowly, yes.

Alex: Daniel, this was awesome, man. We talked specifics on how you built your team, how you run media, how you track things, full-funnel advertising, how to create it, how to build audiences, your SEO shenanigans, your reviews, and how you track, and call center. This was a blast. I learned a lot. I don’t think you got anything out of it, but thanks for joining us. Thanks for joining us on Ignite.

Daniel: Thank you so much. I certainly appreciate it.

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