Larry Diamond

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Andreea Borcea:
Welcome to the Marketing Mondays podcast, where we explore how we can make your offerings stand out in the health and wellness space. Through conversations with thought leaders and innovators in health and wellness marketing, we'll discuss marketing best practices, case studies, and innovative ideas to help scale your business and grow revenues with impact. I'm excited to be your host. My name is Andreea Borcea. I'm a fractional CMO and owner of the Dia Creative Marketing Agency.

Andreea Borcea:
Welcome everyone to another episode of Marketing Mondays. I am super excited to be here with Larry Diamond, CEO of Mitesco and the Good Clinic.com. My name is Andreea, again, your host, and I am the CMO of the Dia Creative Marketing Agency. So Larry, let's start with a little bit about Mitesco, and I specifically loved the background on the name. So why don't we start there and then tell us a little bit about what you do?

Larry Diamond:
Well, thanks, Andreea. It's great to be here today. Mitesco, when we were thinking of the name for the company, I've been in healthcare a bunch of years, and unfortunately in healthcare, change as inevitable, progress is optional, and so the name Mitesco in Latin actually means progress, and that's really what we're focused on, it is being able to help the health system evolve so that consumers have better experience and better outcomes.

Andreea Borcea:
Very cool, so what about the healthcare system first inspired you to need to make a change, to create something like Mitesco?

Larry Diamond:
Well, it's interesting, you know, and I think it's very apropos for your audience because marketing research you can do primary, secondary. We did a ton of secondary research looking at what's been done, and it's very clear that's out there what consumers want. They want something that's about them, that's personalized, that takes into consideration all their issues, their behavioral health, their stresses in life, medicines, the challenges that they have. And unless you're addressing all those things, they don't feel as though they're getting what they want. And since healthcare has gotten so expensive, they believe they should have a much stronger voice in what they get. The other thing is, that they're asking for is, they want something that is personalized to them, they want it to be reasonably priced, and they want it to be convenient. So much of healthcare is organized for the convenience of the providers as opposed to for the convenience of the consumers. And so at Mitesco, we took those, and the Good Clinic, we took those all into consideration and said what do we have to do? And so we've built a model that addresses each of those issues for the consumer, recognizing as so many other parts of healthcare, it has become a consumer product, and we are the first ones really to building it as such.

Andreea Borcea:
That's incredible. Do you feel like we are now at the point where consumers actually are driving healthcare to the point that doctors, providers, hospitals are listening to the consumer? Or do you feel like that there's still this challenging dichotomy between the two?

Larry Diamond:
There still is a significant amount of dissonance. Payment is the strongest form of inspection.

Andreea Borcea:
That's true.

Larry Diamond:
And so when you look at it, it is the government drives so much of the reimbursement, and it's only relatively recent that they've started paying the healthcare system for outcomes and the quality of care that's being provided. It always previously was about units of production, how many tests, how many surgeries can they do? And finally, we've evolved as a healthcare system to start paying providers to deliver outcomes that are improved. The other part of that, there are a lot of people who can't afford health insurance, and so they're paying for it out of pocket. And so when that happens, they expect something very specific. And if you're not able to deliver to their needs, they're not going to come to you. And so their voice is getting heard, just like it's always been heard in things like plastic surgery, right? It was always being consumer-pay. And so finally, primary care and orthopedics, so many of the things are finally waking up to the fact that they have to really meet the patients' requirements as opposed to what the insurance companies or the government is asking for.

Andreea Borcea:
Definitely, and I'm curious too, are patients or consumers at this point aware enough of their health, or are they still driven by acute issues? So do they know to start thinking about outcomes before it becomes an issue, or are they still based on your usage finding that like, nope, I just come to a doctor when I have a problem?

Larry Diamond:
Well, there's a very large portion of the population who sits in that group. I think it's important to remember that we're not all the same, and it's never been really possible previously to identify the buckets of consumers that are out there. The interesting thing is Dr. Hibbert of University of Oregon discovered this consumer measurement tool called Patient Activation Measure that actually puts us into four groupings, and it answers the question, does a person have knowledge, skills, and confidence to be good and effective users of healthcare? And as you would expect, it's about 25% in each of those groupings. And so for a lot of people, and it's also because of how we've been trained, we spend 15 minutes with a doctor, we go to urgent care because we can't get in to see our primary care provider. You know, I think today in America, it's somewhere between 2 to 5 weeks to get in to see your primary care provider. At the Good Clinic, we actually focus on same-day, next-day appointments, radical concept, it's much more about organization. Typically, you're spending 15 minutes with your provider in the healthcare system in primary care. We actually, right now, are averaging about 37 minutes that we spend with a patient, and our target on a first visit is an hour.

Andreea Borcea:
That's incredible. How are you getting, I mean, how are you getting that across to consumers when they're first finding out about you? Or how are you even first identifying the right customers to reach out to let them know that you exist?

Larry Diamond:
Well, we very much, we attempt to market to all groupings of folks, and what we're finding is, is the folks that are more activated and participatory in their healthcare today are the ones that come in, I'll call it, on their own, because they're interested. Either the healthcare system has not met their needs as is, or they're just interested about having a better experience. The other groups come in, as you said when there's an urgent or emergent need, and so they have a sore throat, they have earaches, they have some other blood issue, they had COVID. We're getting a lot of people to come in for vaccines, COVID tests, things like that. So they come in and now they discover that there's something that's actually different and they've never seen before in the market.

Andreea Borcea:
That's incredible. Do you find that people are getting more comfortable with digital being part of their healthcare?

Larry Diamond:
You know, there's a great study, CVS just released their consumer study, and surprisingly, consumers see a relatively low value in the digital. I say digital, I see, I really mean telehealth. They want telehealth on a, just on an on-demand basis if they can't get in to see in person. Now, what we're doing is that we're using the telehealth to support the care plan, because when we meet with someone, we create a care plan, and we have follow-ups. Just like your dentist does, just like your veterinarian does, we plan out what we're going to do with someone, and we, it's a co-developed plan. And so we may use telehealth, it's the choice of the consumer to simply follow up. How are you doing with this new medication? Have you made progress on your change in your diet, so that as a result, we can have a very short 15-minute call with the person, check in, and see what's happening? And since now the government pays for those follow-ups, we're able to focus on prevention and measure and help a person make progress instead of waiting for them to fail, come in at the end of the year or next year to see, hey, they weren't successful. I didn't understand that.

Andreea Borcea:
Yeah, do you see that like a lot of people then are coming to you as, on a referral basis because you're changing the way that, let's say, I implement my own healthcare with this longer-term relationship with the Good Clinic, and then I'm sharing that with friends and family, or are you still finding that you have to do a lot of outreach marketing?

Larry Diamond:
Well as a startup, so we opened our first clinic in February of last year. It took us until September to get into the insurance networks in Minnesota. And so really, and then we've been building clinics. We have six clinics that are open right now. And so really, it was really January this year, and so we have to let people know we're there. So we're doing a lot of marketing in the communities, but referrals are the best way, and we're getting a lot of them. We have only five-star Google ratings out there right now, and if you get a chance to look at them, they are life-changing comments about how different it is that they are clinicians, which are nurse practitioners. So we're all nurse-practitioner-lead, and the difference there is, remember nursing is first off, it is a Ph.D. degree now at most universities and so they are doctors of nursing. They actually have a training that is very broad, so it includes complementary and alternative medicine, includes discussions on yoga and other things that are not standard medical, in addition to all the things that are standard medical. So you can come in and you can talk about everything based upon what's important to you, supplements, essential oils, whatever it is, we can answer the questions that you need. The other thing is that nursing specifically focuses on working with a person longitudinally. And so the expectation of the providers, I'm going to work with this person little by little to help them achieve a goal where unfortunately medicine in America today has been focused on one and done. I'm going to write a script, I'm going to do a procedure, I'm going to move on to the next. And the other challenge is that so many primary care practices are actually part of the healthcare system. And the goal is to be the filter to find high-cost events, people who need angioplasty, stent placements, radiology services. And so as a result, it really doesn't give that primary care provider the time necessary to help a person stay healthy and focus on prevention. They're really just in time reactive to what's happening instead of being proactive.

Andreea Borcea:
That's such a change in the entire business model, I think of primary care and it shouldn't be, because I feel like that's what primary care used to be, and then, you're right, the whole market just evolved. Are you finding that, as people are moving through their care plan, that, you're thinking through how to scale the business and what the capacity is of each of these nurse practitioners? Because in some ways I'm thinking like, things should get a lot easier because people are healthier longer term, right? Because you're catching things early, but at the same time, if you grow, like will they continue to have that kind of time that they need to effectively work on your business model?

Larry Diamond:
Yeah, you know, it's interesting, there was a change made in 2021 where they changed the documentation rules, and they made it easier for clinicians to spend time with a patient. So they're actually reimbursements for 15, 30, 45, and 60 minutes. And so those exist out there because the documentation is easier, it's more available to do that, number one. Number two is that's about scheduling, it's just about any other business. If I have you coming in and I know what you're coming in for, I can schedule the appropriate time. And so we focus on minutes of care, for example. We don't focus on the, so to speak, on the revenue or the number of patients that we're seeing per day, per hour, per clinician. It's really how many minutes of care are we providing out there. And when you focus on that, it, whether I'm providing in a day, if I'm seeing eight one-hour appointments versus sixteen 30-minute appointments, or do the math, get smaller and smaller, right? That's the way it works.

Andreea Borcea:
Interesting, I love how you've broken it down and really kind of reworked, and you're using the people in the system that already are strong and probably underutilized nurse practitioners, probably underutilized quite a bit. In that sense, it gives you a lot more flexibility, I think, to provide the right care. Do you then work with partnerships if there is something more severe that needs to happen like a surgery or is that also included in the Good Clinic?

Larry Diamond:
So actually, great question, it's important to understand, actually in 28 states, nurse practitioners have the full scope of practice equal to a physician, and in all the other states, it just requires a physician to sit in a QA process just overlooking the NP. That'll all change. We'll get to 100% nurse practitioner coverage in all states eventually, and it's just because docs coming out of medical school do not want to be primary care providers. For what it costs to become a doc, you can't afford to be a, to really be in primary care anymore, and so very few physicians are going into primary care. The other part to your question is, what can a nurse practitioner do and how do we work with the specialists? So we have the ability to refer, actually, we understand from an insurance company, do they have preferred providers to make sure that the cost to the patient is as minimal? You know, if they have a very efficient provider, an orthopedist or endocrinologist, we can refer into those or we can refer based upon what the patient asks for. But because the nurse practitioner has full scope of practice, you know, they can do a biopsy, we can actually set a broken arm, we have partners for radiology so they can send them out, get an x-ray, and they can come back and set that. For the more complicated procedures, absolutely, we have referral relationships in our communities.

Andreea Borcea:
Let's talk a little bit more about these insurance companies because a lot of other health startups have challenges sometimes connecting with health insurance companies and getting sign-off. Speak a little bit more about how you built those relationships and got them to buy in.

Larry Diamond:
You know, it takes time. There's a shortage in America, according to the American Medical Association, of somewhere between 25,000 and 35,000 primary care providers in America. And because of that shortage in most markets, the insurance companies are really excited to have someone come in offering primary care. You know, when you take care of someone prospectively and prevent disease, it always costs less, and that is everyone's ultimate goal here. So the insurance companies, you know, when we were one clinic now, they really didn't want to talk to them, now that we're six clinics, they're very interested in talking to us. And so as we go from state to state, city to city, you have to begin, it takes a little bit of time to build those relationships, but a bunch of us come out of the insurance industry, so we have contacts, we push it forward. And as they start to see our outcomes, because we're confident our outcomes will be superior to most other primary care practices, they're going to want us in their networks.

Andreea Borcea:
So what other states are you planning on expanding to next?

Larry Diamond:
So right now we have the six clinics, Minneapolis, and Saint Paul. We have two clinics under construction in Denver, Colorado. So that's our second state and we'll be expanding there towards the latter part of this year, and then we're looking at Arizona and Florida as follow-on states, and we're always exploring what are the interesting markets. New York just approved full scope of practice for nurse practitioners, so they might pop to the top of the list as an interesting market for us to look at.

Andreea Borcea:
So how are you evaluating which states feel like a good next step as you're scaling?

Larry Diamond:
So for us, I think the three core components are a receptivity to something that's a little newer in the marketplace. We're nurse practitioners, we locate our clinics in really disproportion, in the first floor of high-rise apartment buildings. We want to be really convenient. So it's really looking at populations. So we're looking for population density. The next component is there has to be a shortage of primary care providers. And then the third thing is we have to have good relationships with the insurance companies. So we look at where is that possible. So that's really how we look at the markets that we want to go to and we'll continue to grow. We're a public company, so we go to our shareholders in other ways to raise money in the marketplaces. The speed of growth is directly dependent for how fast we can raise capital to do so, and we have a team here that's experienced. We actually have the team that helped scale the company MinuteClinic, if you're familiar with that, that was sold as, yes? So they were very successful creating an urgent care type of retail health environment, and they figured that they could do a better job focusing on primary care, and that's how we got to this business plan.

Andreea Borcea:
Incredible, I was just about to ask you, how do you form your team from initial concept through where we are now? You know, who did you feel is the most critical as part of your marketing team and outreach team?

Larry Diamond:
Well, you know, from, the providers, obviously, because they're the ones that are face to face and because we have the team that was very instrumental in increasing the scope of practice for nurse practitioners, they have a certain celebrity persona in the marketplace, so we're getting a lot of nurse practitioners that know them, number one. Number two is the average, we're told, as nurse practitioners very often have to see somewhere between 25 and 27 patients a day. That's exhausting, and so for this to be able to focus on a patient and really solve their problem, it's a much more satisfying experience for the nurse practitioners. From the marketing perspective, we have a really nice marketing team that's both in-house and then partners that we have that we've built that are very familiar with digital marketing, and then we do a lot of community-based marketing. So we're at all the fairs, we work with the chambers of commerce, we work with all the business groups in town, we work with the cities. So we're working with the fire departments and the police departments to do their physical exams, their DOT exams, things like that. We want to be a part of the community because healthcare is local. And so unless you're local, you really don't understand the issues that consumers are going to run into, and that's why we've really designed this not only from a digital perspective but really being involved in the communities.

Andreea Borcea:
The community, I think, is the really strong way to build that trust too, that you need to feel like you're connected, and the doctor used to be part of your local community. And then everything got big and then you bounced around from doctors with insurance companies and you lost a lot of that. I like that you're bringing it back to that core value of who your doctor used to be.

Larry Diamond:
I mean, kind of interesting, so we're working with Lennar. We are, two of our clinics are, one's in Minneapolis, is in the Lennar Tower, downtown Minneapolis, and another one in Colorado is in the Lennar Tower. And they view us as an amenity to their building, just like the swimming pool or the gym. And so they cross-market and promote because if healthier people are going to, if it's in convenience, if they can communicate to their residents that they're going to hold on to their residents longer, it's going to help them raise their rents and really improve the quality of life for their residents.

Andreea Borcea:
I believe that. It's funny between the fire department, police department, and these corporate partnerships, I'm wondering, is the angle more to work with these larger organizations of some kind or another to be able to provide your service to all their employees, or members, or, I guess, residents of the corporate building? Or do you think, are you focusing still your marketing on individuals and reaching out to families at these health fairs?

Larry Diamond:
Well, absolutely, the individual is the prime target right now. With the new year, though, COVID has changed travel patterns in our community. Very few people, I think, go to work every day these days. They work at home, so many, who have jobs that can do that. And so one of the things that used to be very popular at large corporations and mid-size was this onsite clinic concept. And the fact is because we have a network of clinics and people are not going to work every day, we will be introducing shortly a program for employers that they can buy unlimited primary care from us, for their employees and dependents, and they can go to any of our clinics in the community. And what we know, and the industry knows, that that typically reduces the cost of care because you have convenience, you have a relationship. We don't charge copays in those situations typically because the employer doesn't want it to. We offer all generic drugs at a very low price. So the whole idea is to make it very easy for people to get issues and questions answered in a very timely manner. So the biggest challenge into healthcare, the longer you wait to address something, the worse it's going to be and the higher the intervention. And so by making it easy for people to get answers to their questions, get issues addressed, you eliminate a tremendous amount of, I call, sicking-in to the health system.

Andreea Borcea:
That feels like the most impactful way of reducing the larger, more expensive things that happen later on, right? As doctors want to focus on these specialties, you're helping them prevent that long-term. I love where this is headed. So I guess if you were to start this over again today, is there any lessons learned that you would change or alter starting over?

Larry Diamond:
You know, the funny thing is the hardest part is the capital side. You know, we never expected there to be this economic condition. You know, we have a war in the Ukraine, we have interest rates rising, which makes it difficult, more difficult to finance these. We have some great statistics that are showing the evolution and the growth and the adoption, and the consumer response is incredibly positive. And so it's just starting off that question, we started off kind of an unusual way. We're a public company startup, and that's really unusual. Either you would do this as probably a private equity company and then you'd wait to come to market. So, good news, anyone out there can actually purchase shares in our company any day. We know every day what we're worth, so to speak, in the marketplace, but we're going to be raising money, and with the interest rates going up against us, it gets more costly.

Andreea Borcea:
Is that why you started as a public company so early on?

Larry Diamond:
We had a public company vehicle and we found this concept and we really liked it. I've been in healthcare for over 30 years now and it was because of the changes that have occurred by the government's leadership to start paying for outcomes and to start paying for time to spend with primary care, we now could focus on primary care becoming a good business. Up until recently, you really couldn't make money in primary care. We now can make money in primary care and provide excellent service to our customers.

Andreea Borcea:
Yeah, that's a critical shift and I think lowering healthcare costs for everyone long term because it is encouraging the right behavior to catch things early, and I love that you're a partner in that. Wonderful, so, Larry, any final thoughts on the healthcare space, where it's headed, and how to connect with the right customers or providers or whoever you're connecting with in this space?

Larry Diamond:
You know, it's, for us, the marketing piece, obviously, we somewhat have an advantage in so many ways because we are building a consumer product. So the Good Clinic, when you walk into one of our clinics, it looks and feels the same. We have some core principles that we do a significant amount of education of all our employees about being present, about caring, about being participatory with our customer. And so in the same way in any other consumer packaged goods company or any target corporation, you walk in the look and feel is the same. That is our goal, is to make sure our look and feel is the same. And it doesn't feel like a doctor's office. It's very approachable, very comfortable setting so that people are relaxed and they don't have that white coat or that nervousness of going into the office. So when you have that brand and that concept to be able to go out, we have the ability, obviously, finding our customers for the first clinic we open in a market is much more expensive than the 10th clinic. And so it's, we try to take advantage of that. We're always learning, and that's, the other thing is that healthcare historically hasn't learned from marketing as to how to get to consumers, and so we're trying to bring a lot of knowledge from other industries to make sure that our, you know, we look at our cost per customer. What does it cost to bring a customer in? And so we manage to that and figure out what are the best ways to get to people.

Andreea Borcea:
And that's so important, and I really think that's the differentiator here, right? I think medical and health was always put on the back burner as something that like, that's just something I have to put up with. But with companies like yours coming out and considering brand, and cost per acquisition, and messaging, and the user experience throughout every step, that to me is one of the biggest revolutions in healthcare at this point because that changes the game. It makes it feel like an expected experience you'd get in anything else that you're doing in your day-to-day life, right?

Larry Diamond:
Absolutely, and, you know, it's just recognizing the customer has tremendous power, and if they're not getting what they want, they should go somewhere else. And the fact is that if you're not addressing all the needs, which is really what we focus on and we're really excited to see the reaction we're getting from consumers when you see that response and the referrals that they're sending their friends and family in, you know, you've struck a chord and you're connecting.

Andreea Borcea:
I love that. That's so powerful, Larry. Well, thank you so much. I super appreciate you taking time with me. I'm excited to see where the Good Clinic goes, and now I know I can buy some stock, too, so that works.

Larry Diamond:
Excellent, have a great day. Thank you.

Andreea Borcea:
Thanks again for listening to Marketing Mondays. If you have any marketing questions at all, feel free to reach out to me directly at DiaCreative.com. That's D I A creative.com

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Summary:

Consumers are currently driving healthcare. 

In this episode, Larry Diamond, CEO of Mitesco and the Good Clinic, talks about how Mitesco and the Good Clinic are helping the healthcare system evolve so that consumers have a better experience and outcomes with their health. Larry explains how they view it as a consumer product, bringing their needs to the center instead of what governments or insurance companies typically ask for. This means personalized, complete care that is convenient and reasonably priced. He exemplifies how the Good Clinic focuses on same-day or next-day appointments that are 37 minutes on average. He talks about referrals and community-based marketing as a means to let the right customers find them. He also discusses the benefits of the Good Clinic’s nurse-practitioner-led care and how primary care can become a better business.

Tune in to this episode to learn how the customer has the power to turn healthcare more proactive!

About Larry Diamond:

Larry Diamond has more than 25 years of executive leadership driving growth and profitability at both public and private companies within health care services, population health, patient engagement, telehealth, analytics, government programs pharmacy management, medical device, post-acute care, and healthcare technology. His operational roles have covered general management, M&A, marketing, sales, operations, product development, customer service, and strategic planning. His career has spanned some of the largest companies, like United Health Group, to early-stage companies like PointRight and InsigniaHealth. Mr. Diamond’s breadth of experience enables an acute strategic vision, to organize growth-oriented, profitable business models through delivering customer value. Larry earned his MBA in Marketing and Finance from the University of Minnesota’s Carlson School of Business and his BS in Business Administration for the University of Richmond’s Robin’s School of Business.

Things You’ll Learn:

  • Mitesco wants to help the health system evolve so that consumers have a better experience and better outcomes.
  • The Good Clinic focuses on same-day or next-day appointments averaging about 37 minutes and hour-long first visits.
  • Dr. Hibbert of the University of Oregon developed a consumer measurement tool called Patient Activation Measure that puts them into four groupings answering the question: Does this person have the knowledge, skills, and confidence to be a good healthcare user? 
  • In America, it takes between 2 to 5 weeks to get in to see your primary care provider.
  • Nursing is a Ph.D. degree now at most universities.
  • In 28 states, nurse practitioners have the full scope of practice equal to a physician.
  • According to the American Medical Association, there is a 25,000 to 35,000 primary care provider shortage in America.
  • Mitesco will be introducing a program for employers where they can buy unlimited primary care for their employees and dependents and go to any of our clinics in the community.

Resources:

  • Visit the Día Creative Website for solutions to any of your marketing needs.

Title Options:

  • Consumer-Centered Care
  • When the Consumer Dictates where Healthcare Goes
  • Mitesco Changes Primary Care

LinkedIn Post

Consumers are currently driving healthcare. 

In this episode, Larry Diamond, CEO of Mitesco and the Good Clinic, talks about how Mitesco and the Good Clinic are helping the healthcare system evolve so that consumers have a better experience and outcomes with their health. He talks about current challenges in primary care in the United States like:

  • There is a 25,000 to 35,000 primary care provider shortage.
  • It takes somewhere between 2 to 5 weeks to get in to see your primary care provider.

Consumers want personalized, complete care that is convenient and reasonably priced. Tune in to this episode to learn how the customer has the power to turn healthcare more proactive!