Episode 20: Reputation Development … And Beyond!

Providers don’t always have visibility into areas of the patient experience that become common pain points such as call trees and websites. Reed Mollins, CoFounder and Chief Strategy Officer at Doctor.com, describes the difference between reputation management and reputation development. The conversation then pivots to the leading edge of doctor listings data and its part in cleaning up and connecting other parts of the healthcare ecosystem, all of which benefit patients.

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Full Transcript

Announcer: It’s time to think differently about healthcare, but how do we keep up? The days of yesterday’s medicine are long gone, and we’re left trying to figure out where to go from here. With all the talk about politics and technology, it can be easy to forget that healthcare is still all about humans. And many of those humans have unbelievable stories to tell.

Here, we leave the policy debates to the other guys and focus instead on the people and ideas that are changing the way we address our health. It’s time to navigate the new landscape of healthcare together. And here are some amazing stories along the way. Ready for a breath of fresh air? It’s time for your paradigm shift.

Michael: Welcome to “The Paradigm Shift of Healthcare,” and thank you for listening. I’m Michael Roberts with my co-host Scott Zeitzer. On today’s episode we’re talking to Reed Mollins. He’s cofounder and Chief Strategy Officer at doctor.com, a healthcare reputation management company. Reed, thanks so much for being on the show today.

Reed: Yeah, my pleasure. Thank you, Michael. Thank you, Scott.

Michael: So obviously, reputation management and reputation marketing, so just a quick aside, we kind of, when we’re talking to customers about it, we say like, “Hey, we think of management as if you’re in trouble and you need to fix something,” but there’s such an opportunity around marketing and really getting your name out there and really continuing to show how patients are really on board with what the physician’s doing and really on board with what the practice is doing.

So this is, you know, where we as two companies, doctor.com and P3 Inbound, how we work together on this. But I wanted to kind of dig into a little bit more of doctor.com and learn more about your story. How did doctor.com come into existence?

Reed: It’s a great question and actually in a lot of ways it’s foundationally connected to the comment that you made to open. We also tend not to think about it as reputation management so much as reputation development. When you look at the ecosystem, what you see is that the average provider doesn’t really have any reviews. The average doctor, even if they do, they have 2.4 reviews. It’s just like not enough feedback but 80% of patients are looking for this feedback before they’re willing to make an appointment, even if they get a referral from their primary care.

So we looked out at the ecosystem. We said, “All right, there’s not enough doctors out there with enough reputation for the patient demand or the information. And there’s all these ecosystem partners, these places that patients go, the Vitals and Healthgrades of the world that are looking to have enough content and enough feedback to really enable patients to make good decisions.”

And so, we said, “All right, how do we work on reputation development and how do we do it in such a way that the doctor can be in control and these consumer destinations can get what they need so that the patients can get what they need to make great decisions?” So foundationally, I think I’m fully on board and in agreement with the way that you all think about the ecosystem itself and think about reputation.

In terms of the existence of the company and the way the company was born, it’s a little bit of an interesting story. So there’s me and there’s Andrei Zimiles, Gary Millen, and Andrei and I have been best friends since we were nine and we always knew we wanted to work together, solve big problems, try to find something exciting that really we could sink our teeth into.

And we met Gary back in I guess it was like 2010, 2011 and he had one of the largest portfolios of domain names in the world. And we looked through the domain portfolio and doctor.com was a project that he had been thinking about a long time. And we just immediately latched onto it because, you know, Andrei and I are both technologists and we were, you know, kind of, I don’t know. It’s easy to be depressed looking at how much technology is spent on like photo sharing apps and things that aren’t meaningful. And we had both really been excited by the opportunity to really sink our teeth into problems that actually affect people, actually affect their lives. And so doctor.com and the opportunity in healthcare just became really, really clear.

Scott: Yeah. You know, I always look at doctor.com and reputation development, reputation marketing to be an empowerment tool both for the patient who’s desperately trying to find help with their health. That’s hard to say, and as well as the doctor. I can’t tell you how often I’ve been on the phone with a doctor that has been in practice for a long time and is just frustrated by the fact that “Wow, my numbers look terrible.” It’s like, “Guys, there’s a reason for that.” You’re not talking to them about it, to your patients, and most of the conversations your patients are having is actually with your staff.

I work with a lot of surgeons, so I said, “Most of your interactions there are sleep.” They usually laugh a little bit and I kind of walk them through. Doctor.com does an interesting thing. They don’t just say like, “Hey, when you go home, fill something out.” You actually provide them with a Chromebook.

Reed: Yeah, exactly. So we came up with the idea of in-person patient feedback collection. And we wanted to do it on a device that had a full keyboard because we felt like, you know, maybe you get a text message and maybe like one out of a hundred people writes a little quick thing on their phone about the pizza restaurant they went to and like maybe that’s enough reviews and enough content for somebody to make the right decision about where they want to eat pizza. But if you’re considering a surgery and you’re looking to other patients’ feedback as an important mechanism, you need to learn more than that.

And so, we were immediately trying to figure out what was the best option. So we looked at all the different hardware opportunities out there and we decided to go with Google Chromebook because they’re super easy to deploy. They’re basically impossible to break from a software perspective. They’re so secure and they have that full keyboard, a nice touchscreen.

And so, when we started putting those out in the world, we started seeing doctors who had gotten like two reviews over their entire career start to get like multiples per week, multiples per month in these like beautiful paragraphs of text about what the patient’s experience was really like. And it has just been an absolute game changer.

Scott: Yeah, really. You know, if you think about it, if you’re a patient, you get to see, you get a little insight into how the doctor is, get good expectations, what some of the nuances are about the practice. And it gives an opportunity for the doctors in the group to get some good, honest feedback about what they’re doing well and what they can improve upon.

And I’ll tell you, if you’re a patient listening in, normally, it’s not about the doctor. Normally, it’s about the intake system. Like, so in other words, who’s the person who is behind the glass door when you walk in? Who manages the insurance and the bill payment? You know, there’s an entire process going on and I can’t tell you how many surgeons have thanked me and said, “Man, I didn’t know so many people were irritated about bill payment.” And it’s like, “Well,” but it’s allowed them to improve what they’re doing.

Michael: I think they are trying to distinguish between, “Look, I don’t want to pay a lot of money.” So everybody’s irritated about like, “Oh, I’ve got to pay a bunch,” but then understanding like where the breakdowns are. So, and I’ve talked about this on the show before where, you know, we have a family member that has to deal with a lot of medical care. And just so many times where those breakdowns occur it’s like, “Is there anybody else that I can talk to about this? Is there somewhere higher up the chain that I can go to say like, somebody in the billing department just seems to be falling down on their job?” And if there’s honest feedback that goes out there like that, that’s not necessarily my first recourse to go, you know, broadcast it that way but it does bring it up.

When you start seeing trends from like a management perspective, if you’re the physician, if you’re the person that’s running the practice and you’re seeing these issues pop up again and again, hey, there’s something that’s got to change. It’s not just people don’t want to pay. It’s, “This is a painful process to get it done,” which is a completely different issue.

Scott: And on the positive side, if you’re seeing lots of positive reviews about like, “Wow, we work with a lot of total joint replacement surgeons,” you get a person who’s saying like, “Man, you know, I went in. He told me this was gonna happen. I had my joint replaced. I can walk. I’m more, you know. I love the PT people,” these are the kinds of things that patients need to see.

Reed: Absolutely. It’s funny. There’s actually two additional elements for us from a technology stack perspective where we enable call recording and call tracking. And we initially built it so that we could help doctors understand, “Okay, where am I getting my new patients from? Am I getting my new patients from the internet or am I getting my new patients from referrals?” But pretty rapidly, we sort of understood that the call tracking and call recording is actually informing the doctor about what the patient’s experience with their staff was like.

We started having clients come back and say, “I listened to these call recordings. Like I didn’t realize people were waiting on hold for five minutes. I didn’t realize that when someone called in they hit like a voice tree that took what felt like two hours. I don’t understand.” And helping them sort of redevelop and rebuild their business from those experiences.

Scott: We had a guy in the South and he had no idea about that call tree because I always tell my clients like, “Don’t dial your private line, you know, to the office manager. Just make believe you’re a patient and dial that front line. If you’re cool, then that’s fine. And if you’re not, hey, maybe that’s something you need to look at.”

Reed: Yeah, exactly. Exactly. And there’s so many elements of the business where I think that the doctor doesn’t necessarily have great visibility, you know, and that one of our really missions is to try to give the doctor visibility onto areas of their business and areas of the patient experience they might not necessarily see.

So we have a suite of products around reputation and one of them is a product called Reputation Insights. And Rep Insights, what it does is it ingests all of the consumer patient feedback in places like Vitals and Healthgrades and Google and Yelp, places like that, as well as ingesting all of the CG or HCAHPS scores and depending on whether the doctor does them or not, pulls all of that content into one place, uses semantic analysis to parse the comments out, and then uses thematic tagging to understand sort of what each element of the sentence is about and then puts sort of analysis on top to say whether it was good or bad sentiment.

So it’s like first it’s semantic, and then we do this thematic thing, and then we apply the sentiment to it. And when you get enough content into this machine, we’ve been able to tell hospitals and health systems like, “Hey, it looks like on Thursday in this particular facility wait times must be crazy because you’re getting these negative reviews about wait times and it’s only happening on Thursday at this facility. So what do you think is happening there?”

And then they dig in and they find out, “Oh, we’re understaffed on Thursdays because there’s somebody who is out or has other responsibilities,” and that when you take a Rep Insights tool like that and you start dumping enough data into it, you can start to surface some really amazing pieces of information that can really help you not just sort of improve your business, but again, develop your reputation because you’re seeing what the patient experience is like.

Scott: Yeah. You know, Reed, it’s interesting from my perspective, like a lot of patients and even myself, if I have a bad experience, I’ll come back thinking like there’s somebody like Mr. Burns from the Simpsons in the back going, “How can I make their day worse?” And it’s like that’s not the case. When I come back with this type of information to my clients, they’re like, “Oh my God. How do we fix this?”

There’s no one who’s trying to make it difficult. But to your point, those insights, it could very well be that Thursday afternoon somebody…maybe there’s not enough people. They’re understaffed. It could be like they didn’t realize they needed more staff because there’s another doctor that happens to be in. Like what would one extra doctor mean to the clinic? Well, apparently more than you thought. So that’s just great stuff for everybody. I mean, that’s the real win in in my mind.

Also setting expectations, you know, about… I have a good friend of mine that I’ve known since he was in residency, an orthopedic surgeon. He tends to take a lot of time with each of his patients. He will not leave them until they’re very, very comfortable. And he was getting some feedback online that frankly he was always behind by about 5, 10 minutes. And he put something on his site which basically said, “I get a lot of feedback that I’m late and, it’s like, I am. I’m gonna take the time to talk to you and I’m not gonna stop talking to you until I know you’re comfortable and healthy. If you want to come in and be processed quickly and efficiently, I may not be your guy, but if you want to come in and you really want to be taken care of, I’m your guy.”

And his ratings went up because the patients were like, “Okay, that’s cool. You know, I’m okay with that. I’d rather be taken care of in that manner.” And I’m sure some patients have said, “No, I want to come in at 10, I want to be seen at 10, and I want to get out at 10:15.” Well, okay, you should go somewhere else. Like that’s perfectly reasonable for everybody. I have a question for you.

Reed: Okay, shoot.

Scott: So like any small business, you guys basically say like, “Here’s what we’re going to do,” and you think everything is settled, and then things change. So how much has the company changed since the beginning? Like what surprised you the most?

Reed: It’s a great question. I think the thing that has been most surprising to me is that the broader ecosystem is so interested and invested in the data that comes out of the work that we do, that we’re starting to be approached by institutions of all sizes and shapes to help them with things that we weren’t necessarily expecting.

So what I mean by that is that, you know, we’ve gotten really, really good at understanding doctor data. Who works where, what do they do, what are they good at, where did they go to school, what kinds of procedures are important for them? And that kind of data at the scale at which we’re collecting it has started to sort of become apparent to all kinds of different players who we never really thought we’d talk to. We have started working with an organization that’s a real estate company that helps hospitals and health systems figure out what facilities to buy.

Scott: Interesting.

Reed: We started getting approached by a private equity who owned some of these like, kind of like large becoming conglomerate dermatology or becoming conglomerate, you know, a vision center and certainly getting pushed by organizations to help them figure out which companies to buy, you know, which practices should be the right practices to acquire. We’ve started working with pharmaceutical companies. We work with payers. We did a big RFP with a large state government. Medicaid institutions are coming to us, patient financing.

Basically, what’s happened is we’ve gotten so good at helping doctors position themselves online and helping patients and the institutions want to help patients find care that the amount of throughput of information and the skills and expertise we’ve developed in processing that information has just made us globally a more interesting healthcare tech company. And a really sort of fascinating side effect of just doing good work for doctors and doing good work for patients is that it’s throwing off all this additional information that can help improve the system as a whole.

I hadn’t really thought about how interconnected all of the different players in the healthcare ecosystem really are. It really is an ecosystem. Everybody is…all the different stakeholders are in this kind of complex web and as we do more work with each element, it just makes us more effective and for all the other stakeholders. I think that’s the part that’s been the most surprising for me.

Scott: Yeah. You know, that that kind of leads into my follow up question about I think doctor.com acquired Connect Healthcare, right, at the end of 2017. Is that all part of that connecting the dots kind of an equation or thinking?

Reed: Yeah, exactly. Exactly. So Connect Healthcare had been around for 20-plus years and was doing a huge amount of work with hospitals and health systems where the traditional doctor.com business was all private practice. And so, combining forces, we were able to achieve some considerable scale. I mean ,at this stage I have first party data from a third of MDs and DOs in the country.

Scott: Incredible.

Reed: Yeah. It puts me into a position that almost no other institution can sit in. And what was kind of amazing was the services they were offering were so complimentary and different from the services we were offering that we’ve been able to bring a lot of technology. It was developed for hospitals and health systems into the private practice. For example, that Rep Insight software I talked about, that was a hospital product that we’re now making available for small group practices.

And then we were taking the products and services we developed for the small institution, the small private practice, and making that available for the hospital and health system. So we had developed a whole listings management business. You know, our ability to make updates just to the basic data on places like in Sharecare, Healthgrades and Vitals and WebMD. All of those pipes got built for private practice. We were able to make them available to those hospitals and health systems.

Which are critical, you know, in terms of we were talking to someone over at… What was the company that is essentially the Zapier of…

Michael: We were talking to Redox.

Scott: Yeah, Redox, which makes some great APIs, which is application program interfaces for those who are not geeky like me. They essentially are translation tools for programmers to allow different systems to communicate with each other. And that’s another way to help connect the dots in this ecosystem, all this data.

Michael: Yeah. One of the things that… It’s funny having the two because that’s the episode right before this one. And so, to have the two of you kind of back to back is really interesting.

Scott: Yeah, it is.

Michael: And kind of a happy coincidence. I mean, we planned that strategically.

Scott: Yes, yes, we did. Of course, we did.

Michael: We thought through all those matters. But there’s this ideal, there’s this promise of interoperability, everybody being able to share data, like getting closer to these ideas. And yet there’s been so many roadblocks along the way where, you know, you hear so many times about, “Oh, you know, this system is still stuck in the ’80s or they’re still faxing all their stuff,” but there are positive things happening. It’s just, I don’t think that those stories are getting out as often.

Reed: Yeah. I mean, the number of companies like us who are focused on connecting the dots and creating what is effectively going to be the new healthcare ecosystem, it’s vast. We’re connected to an organization called StartUp Health that has a few hundred companies that they sort of are in their community and the number of them that are focused on trying to make things easier for doctors, make things easier for patients by connecting all the dots, it’s vast.

And I think that there’s a lot of obviously a lot of complexity. There’s been a ton of roadblocks. What’s interesting is that almost none of them are technology. The technology itself is almost never the problem. The problems tend to surface around protective business practices. The problems tend to surface occasionally around regulation or the way regulations are interpreted, but it’s never the tech. We find it’s almost never the doctor and it’s certainly never the patient.

And so, I think it’s incumbent on all of us who exist in this ecosystem and who are really thinking about these paradigm shifts to always keep front of mind like the quintessential benefit of the interoperability because I think there’s a lot of organizations who are not having the pressure put on them that needs to be put on them in order to participate in this big broader ecosystem.

Scott: Yeah, I couldn’t agree more. And I do think the consumerism of healthcare, you know, that is what this paradigm shift is or a big part of it. There’s technology. There’s consumerism, et cetera. It’s gonna force people, and I think for the better, to make some changes in how medicine is delivered and how patients can empower themselves.

When you talk to your parents and/or grandparents, I have these conversations with past generations, like, “So what are you taking for your blood pressure?” And I can’t tell you how many people have told me like, “Oh, I take a blue pill.” What do you mean? Like what’s a blue pill? How am I gonna help you, grandpa, when I tell them they’re taking a blue pill? Like what do you take and how many milligrams do you take? What? Like that kind of stuff. And again, is that the right choice for me? Should there be other people? So I do think having a better two-way conversation. We’ve had a lot of conversations about that too. And this type of stuff helps empower those kinds of conversations.

Reed: Absolutely. Absolutely. We focus a lot on the patient experience and the patient journey and this is sort of one example. We don’t need to go down to the interoperability track for too long, but almost every doctor in the country has a practice management software solutions either baked into their EHR or as a separate piece of apparatus. And almost all of those offered solutions were paid for by taxpayers through meaningful use.

And so, we have a world now where basically every single doctor’s schedule is digital, but still, information about that schedule, where they actually work, what times are available has not been surfaced out to the consumer endpoints. And we power online scheduling for Bing. We do it on Google. We do it for Healthgrades. We do it on Vitals. We do it all over the web. And our ability to gain access to that real time availability is limited.

When we work with a doctor who wants to put their real-time availability out there, not necessarily for like full complete online booking, just so patients can know when they request an appointment at the time is actually available, when we do that, in order to get those times, the doctor often has to go to battle to try to get us the information.

And again, it’s not a software or technology problem. There are business challenges in here. And it’s been our perspective for a long time that eventually we thought the federal government would step in through one of these meaningful use mechanisms, require the kinds of interoperability that make very basic consumerism information available, and to date, it just has not yet happened.

And so instead it’s only the most progressive doctors and hospitals who really are trying to create the best patient experiences, who are willing to go to battle with their software vendors and gain access to the information that they need so that we can create these patient experiences that everybody knows are the future. It’s been a really interesting sort of part of our businesses is navigating the relationships required in order to make all this happen. And I’m very hopeful for the future, but it has been a slog.

Scott: Yeah, I’m sure you have a lot of conversations of, “Why not?” It’s just like whatever it is, like “Well, why wouldn’t you?” I always mention this to people very often. I always say like a lot of people really complain a lot about Microsoft Office having a humongous share of the market for something as simple as Word. And I remember like there was a big battle. I’m old, so I remember the big battle between Word and Word Perfect. And I think lawyers were the only ones who ended up sticking with WordPerfect and Word One.

But the unintended positive consequence was that everybody who wanted to create a page editing application of some sort had to make it .doc compatible. So whether you were pages or I think it’s called Google Sheets or whatever it’s called in Google and, of course, Microsoft Word, it was always this .doc.

And there is something called HL7, which this really basic way of EMRs talking to each other. And I am kind of looking forward to the day when there will be some enforcement of saying, “No, you’ve got to take down some of these hurdles between EMR/EHR system one and EMR/EHR system two.” They’re in there not for the betterment of technology, not for the betterment of patient care, but just to protect market share, and there has to be a way around that.

Reed: Yeah, and it’s interesting. That HL7 organization, it’s an amazing organization.

Scott: Yes, it is.

Reed: That’s this just like phenomenal open stores project that has a lot of excitement and initiative around it. And, you know, the traditional HL7 mechanism was kind of an old school, large file transfer situation. But HL7 FHIR, which is an acronym that I unfortunately cannot remember what it actually stands for, FHIR, has created a real time standard that can allow access to the information itself and does it in a way which is performant. It does it in a way which is secure and private.

Again, it really feels like the future and I’m very, very hopeful and we’ve been participating as thoroughly as we can. And we’re just eager for more and more of the doctor groups to push harder on their software vendors to make it so that that just becomes available for any situation in which that data would be beneficial to the ecosystem as a whole.

Scott: Yeah. We talked to, by the way, FHIR is Fast Healthcare Interoperability Resources.

Reed: Nice.

Scott: No, I didn’t know that. I looked it up while you were speaking. So anybody who thinks I’m that’s smart, no, I’m not. But that being said, you know, when you get this good scrub data, and we talked about it in our last podcast, the ability to take that good scrubbed HIPAA compliant, anonymous data, I’ll say it over and over, and put that into some AI systems to help us understand better about being proactive rather than reactive really will be quite an amazing technology jump.

So we’ve been talking a lot about better systems for helping process people and take better care of them. The other potential, of course, is the ability to be better care providers. And I don’t mean just by the process of walking them through the hospital, but no, I think we could actually figure out how to solve real health care issues. So a lot of positive things. I’m a very… I am an optimist overall, that’s for sure.

Reed: Yeah. I mean, it’s funny when you think about sort of problem solving and where we can go, one of the projects that has been really close to our heart and we’ve been working on this entire time is trying to solve a problem which some of my technology friends who work in other industries sort of make fun of me for, which is right now we don’t have a clean source of truth for who works where and what they do.

There is no national clean source for that. There’s NPEZ [SP] but the last time the Office of the Inspector General tested NPEZ, they found it be 55% inaccurate, which is not really that useful. And at this stage, doctor.com may be the best and cleanest source of truth for institutions who are looking to interpret that data, bring it in, and display it.

And we’ve been able to achieve that by working directly with doctors, working with doctors to help them clean their online presence for marketing purposes, and then we can provide this clean source of truth back to their employing institutions to help make their internal systems better and stronger. And that solving this who works where and what do they do challenge is one which will save our country literal billions.

When you think about all of the missed referrals that go out there, when you think about all the situations in which there’s like some amazing idealized product for population health management or some of the AI systems you’re talking about, the reality is garbage in and garbage out.

Scott: You’re right.

Reed: So if we don’t know who works where and what they do, almost none of those systems have anything that can be relied upon. And we’ve taken it as part of our mission and part of our business model to be one of the ways this gets solved.

And so we’ve done it… Obviously, you can’t do it alone. We do it partnering with every institution we can possibly partner with, every software vendor. And anybody who knows who works where and what they do, we want to develop a relationship with them.

So, you know, we work with some really large and sort of strange players. Like we have a big relationship with Local IQ who is part of “USA Today,” Gannett. And if you think of that it’s kind of funny. Almost every hospital in the country advertises with “USA Today” for their local markets and their local newspapers. So through them we’re gaining access to even more information and helping them do their listings management work.

And so almost anybody who interacts with doctors, there’s a way for us to work with them and there’s a way for all of us working together to break down the many silos that have created a lot of the cost creating problems that the healthcare system is burdened with today.

Michael: Reed, this is really fantastic stuff. Thank you so much for being on the show today. I feel like we could go on for quite some time, but we’ll go ahead and wrap for today. But again, thank you. I think that this is just really, again, we as I think as a show are very optimistic about where healthcare is going and the people that are championing those causes. So thank you for that. And listeners, thank you for tuning in.

Announcer: Thanks again for tuning into “The Paradigm Shift of Healthcare.” This program is brought to you by P3 Inbound, marketing for ortho, spine, and neuro practices. Subscribe on iTunes, Google Play, or anywhere you listen to podcasts.