Why Clinic Owners Shouldn’t Build Their Own Software, PMS Is Not a Silver Bullet, E50 with Jared Aron

0:00Jared Aron: As a healthcare provider, you become hamstrung under this false pretense that you have an all-singing, all-dancing monkey that can solve all your problems. It's like hiring a plumber to fix your pipes at home. And then because they're there, you mind cooking dinner for me. And also I have this problem with my car. Could you go pick up my kids from school? You end up with a Frankenstein of two or three different tools, spreadsheets, all because you went in, you were sold on promise. The promise was my practice management software is going to give me all the tools I need to engage and manage my patients.

0:37Jared Aron: People think about their tech in a healthcare setting. They think about it in the wrong way. They think about a silver bullet. What bullet can I fire to solve all my problems? It doesn't exist. If it existed, then there would only be one practice management software in the market. And it's a really hard thing to do because in healthcare, you're constantly firefighting. The house is always on fire. There is never a time where the house isn't on fire. You cannot vibe your way through some of these requirements. It is a horrific mistake. You are in competition with people down the block. And then when patients go home, you're in competition with Netflix, with Meta, with attention-grabbing machines that you simply can't compete with.

1:17Jared Aron: And so your patients are not your patients.

1:29Jared Aron: Practice management software and EHR, EMR, electronic medical records, patient records are the best and the worst thing to happen to healthcare ever. Why is it good? It's good because if you have a choice between running things on pen and paper and running it on a practice management software, on an electronic medical record, it's no question. You can be more efficient. You can be more organized. You can maintain better clinical records. There are a hundred reasons that medical records, practice management software, electronic medical records, EHRs, EMRs, have done wonders in helping healthcare providers come into the modern era.

2:17Jared Aron: So it's great. It's great in that sense. And also, it has got to be the worst thing to happen to healthcare, possibly in the same duration of time. And that's not a blanket statement for all practice management software. There are some very good practice management software, but many of them are not. And it's not that they're bad. It's not that they're bad because they don't do the thing they say they're going to do well. They do the thing they say they're going to do well. They also say they're going to do all this other stuff that they do not do. And so as a healthcare provider, you become hamstrung under this false pretense that you have an all singing, all dancing monkey that can solve all your problems.

3:04Jared Aron: I spoke to a clinic owner recently who said they're thinking about changing practice management software. They've been on the same practice management software for three or four years. I said, okay, interesting. Why? Oh, this other one also has a marketing suite. That's interesting. Marketing technology MarTech. That's a thing.

3:27Jared Aron: It's a thing. You also have practice management software. That's a thing. EMR, EHR, that's a thing. So now we're saying that someone's figured out how to do both. It's possible. Then he said the practice management software also does some of the back office and bookkeeping. That's a different thing. So now you have a medical record, a marketing suite, and an accounting tool all in one. Now, you could say, wow, that's great, full service. And I think that is probably fair if you compare it to pen and paper. but there are entire businesses that are built around these very specific areas of specialty.

4:20Jared Aron: And what you're saying is that an electronic medical record or a practicing software that was set up 15 years ago that still looks like it belongs in 2005, it has suddenly figured out how to do all the things. It's like hiring a plumber to fix your pipes at home and then because they're there, do you mind cooking dinner for me? And also I have this problem with my car. Could you go pick up my kids from school? That's literally how I find service providers. To look after my entire household, starting from the plumber. These are different things. They're just fundamentally different things. And so you end up with this relationship where the practice management software, it calls itself a CRM.

5:09Jared Aron: which it's not for the abortance of doubt. And this belief that you can solve the entirety of your practice problems inside of a single solution is just deeply flawed. And it sets people up to not be successful. And I'll give you a very simple example. We spoke with a a very successful aesthetics and surgical practice on Harley Street recently. And it is a tight ship. Tight. The operations director there is very on it. Nothing gets by. But how does nothing get by? They have a practice management software, and I should say, actually, it's a good practice management software. It's a modern practice management software, open API is very flexible.

6:01And they have a separate CRM and they have about 14 different

6:06Jared Aron: spreadsheets that they update manually to do specific things that they want to do. Here's an example. Your mind will explode. An example is their medical secretary team, their receptionist team will at the start of every week, go in and update to the spreadsheet, one of the spreadsheets. The next three available appointments for each of the consultants in the practice. That is what you pay a practice management software for. It shows you their availability. It's the one thing that is supposed to be very good. But the reason that they need to do that is the practice management software wasn't meant to facilitate easy booking when you're on the phone with the patient.

6:53Jared Aron: It's a different use case. It wasn't designed to fill those gaps between the patient interaction and the booking flow. And so you end up with a Frankenstein of two or three different tools, spreadsheets, all because you went in, you were sold on promise. The promise was my practice management software is going to give me all the tools I need to engage manage my patients and then you start realizing that isn't true and as soon as you realize that isn't true you start slapping things on the number of practices that we have spoken to who say i use this tool we say oh that's interesting how do you find it fine it's okay so why are you using the tool you don't like it oh my practice management software doesn't do this so i needed this thing Of course it doesn't do this.

7:44Jared Aron: People think about their tech in a healthcare setting. They think about it in the wrong way. They think about a silver bullet. What bullet can I fire to solve all my problems? It doesn't exist. If it existed, then there would only be one practice management software in the market, and it would be that practice management software. It would be the dominant player. There would be no other conversations. People would not need to ask questions about this one or that one. Everyone would have the same opinion. And there are businesses where this happens, right? There aren't 65 versions of LinkedIn. There's one LinkedIn.

8:16Jared Aron: And the reason there's one LinkedIn is because that is where you go to do the things that you need to do. There aren't other places to do that work. There are specific tools that dominate a category. Practice management software is not one of those categories because every healthcare provider has different needs and you can't meet all those needs. You can't have a chiropractor using a dental practice management software. There's custom work, but because there's custom work, if you want your practice to be efficient, you need to be prepared to work outside of the practice management software and not be entirely reliant on a tool that was built for a very specific thing.

8:54Jared Aron: So my general thoughts are when you're thinking about practice management software, hire it to do a very specific set of jobs. It is really good at doing those jobs. it is not a tool that you can twist and contort out of shape to do all the other jobs in a similar way that the plumber is not also your electrician your electrician is your electrician you pay your electrician to fix your electrics you pay your plumber to fix your pipes you cannot crisscross these things don't work that way they're fundamentally different so in general i think practice software electronic medical record fantastic fundamentally different to solving all of my problems in my front office.

9:36Recently, you spoke with quite a few clinic owners as well as on the consolidation part, the roll-up partners, those across dental, across aesthetics, across physio. You've been speaking with a lot of them recently on the podcast. Was there anything interesting or any pattern that you spotted after speaking to people on both sides of the river?

10:08Jared Aron: I think most people who are buying and building right now, we had a guest on a podcast recently who, I think it's a great phrase, he said, the buying and smashing era is over. The buy and smash era. And it's a very visceral word, smashed. Grab this thing, grab that thing, and smash them together. You hope something more valuable comes out. And that is not the case. and certainly his experience in consolidating in dentistry was that that time has passed. And I think the same thing is true in aesthetics, the same thing is true in MSK. You cannot simply buy and assume that efficiency will come as a byproduct.

10:42Jared Aron: I think what's interesting right now, and we heard this recently with a seven or eight site group owner who's expanding right now, who said, unlike any other time that he remembers building and leading this group, the ecosystem is changing. The ecosystem is changing. That's very different than a thing changed. Saying the ecosystem is changing. I said, what do you mean by that? That's interesting. He said, you have new suppliers, innovation coming to the market. You have new players. You have people from outside healthcare coming into healthcare. The melting pot, this big pot that we're putting stuff in is starting to change.

11:21Jared Aron: Things are starting to get mixed up. And as you grow and scale your provider operations, the thing you did to get to where you are is not the thing that's going to get you there. And it's because the things that you can do today are fundamentally different. And I'm not talking about a thin wrapper on an AI receptionist. I'm not talking about a 20 minutes back, 30 minutes back. I'm talking about fundamental replumbing. We work with a multi-site group where we came in, we help them reduce their front office team by full headcount. We increase their booking. We increase their patient engagement. We surface patient insights and problems and concerns from the patients that they didn't know existed.

12:03Jared Aron: And we help them reduce third-party software. You add those things together, you start to see that show up in EBITDA. You start to see that show up in the bottom line, not in theoretical minutes back. Minutes back is a great promise, but But your valuation doesn't improve because of minutes back. Your valuation improves because your value improves, because your profitability, your P &L changes. And I think there's this pattern in healthcare of buying minutes, but minutes needs to show up in the P &L. And so if you're not solving problems that have P &L-level impact, not theoretical P &L-level impact, it's nice to have a medical scribe.

12:43Jared Aron: It's really nice that the patient experience can be more focused, practitioner can be more present, notes are written largely for the practitioner. That's fantastic. Everyone's happier. And sure, happiness is part of value because your practitioners stick around, they don't leave. There are a lot of reasons that happiness helps value. But the thing that helps value is value. I remember we hosted an event recently and there was a speaker there who's currently consolidating in the aesthetic space. And he was asked a question. And the question was, how do you value practice that you buy. And this person said, maybe the revenue is here, the EBITDA is here, but we've got a great brand.

13:21And the response was fantastic. The response was,

13:23Jared Aron: cool, if you have a great brand, it should show up in EBITDA. Your brand is so strong and your patient acquisition and retention is so strong and the brand is so good, you'll see it in the P &L. It'll show up there. And I think this is the thing that I'm hearing from the consolidators that I speak with, from the private equity groups. the innovation is great. Show it to me in the P &L. And P &L transformation is a very hard thing to sell. It's a really hard thing to sell. It's not feel-good vibes. It's not people happy. It's a number at the end of the month. And so when you're thinking about P &L transformation at a consolidator level, you need to be really sure that cost is coming out and or revenue is going in.

14:06Jared Aron: In minutes is the vibes. The minutes are great. We save practitioners two minutes per day 20 minutes per day, an hour per day, was someone there for that hour? Or did they, were they just, was that the coffee break time? Because those minutes, they don't show up necessarily. So I think what I'm hearing is that if the buy and smash era is over, now it's about enabling P &L structural transformation. That is a different, you need to buy different things for your clinic. You need to fundamentally rethink at an organizational design level, how do you enable that change. I think it's different. I think it's a different game today.

14:43Yeah, interesting. We can talk about more about the P &L transformation and what's involved, what's needed to get to that level. But before I get there, I wanted to beyond, in addition to the buy and smash comment that you just mentioned, you just talked about, and also there I've heard quite a lot about some other aspect in the industry i wouldn't say problem just dynamic or patterns in the industry that's happening quite a lot there is apparently a lot of conversation that you had involved the phrase a lot we have a lot in motion right now you can talk about that yeah and then there is also oh i'm building a software for oh yeah my clinic or clinic groups yeah these are entrepreneurs very smart entrepreneur yeah entrepreneurial yeah yeah exploring ways to improve themselves improve their own operations.

15:34So let's talk about these two. Okay. A lot in motion. Okay. And then I'm building, I'm a software developer now. Yeah.

15:40Jared Aron: So a lot in motion. So we do often have conversations with practice executives. We're engaging about coherent services and the extent to which patient engagement, support, activation, retention is a problem that they need to solve. And oftentimes, sometimes what we get to is, this is a problem. We have this problem, but I've got a lot in motion right now.

16:03Jared Aron: I would challenge you to find a single high growth scaling healthcare provider that would ever say they don't have a lot in motion right now. It is one of those businesses where you are always on. I used to run clinic. You are always on. Even when the doors are closed and you have no patients on site, your HVAC goes down. You have a security issue. You have a... It's always on. There's always a lot in motion. And it is because there is always a lot in motion that as a healthcare provider, you get stuck in just turning the wheel. It's a bit like restaurants. You just keep turning the wheel, just keeping the doors open every day, serving people, serving customers, closing the doors on time.

16:44Jared Aron: That is so consuming in a way that it is fundamentally not consuming for a pure-placed software business. Of course, it's consuming in a different way, but you don't have that service-based. This is the service-based component, that service-based challenge. There's always a lot in motion. and the practice leaders, the executives that are clearly bucking the trend, very clearly bucking the trend, line is going down, theirs is going up, are the ones who can say, cool, I've got a lot going on right now, and this is where I'm going to create value. And that focus, that precision is immediately visible.

17:27Jared Aron: When we have conversation, if we're having a sales conversation, We're sharing stories about how we've worked with customers in the past. We've asked clinics to share with us their patient flow. Where are they dropping off? How are they dealing with new inquiries? The practice leaders who are growing at speeds that would hurt your brain in many cases are the ones who are able to say, I've got a lot going on right now, and I'm able to put that all, make it all background noise. I'm going to put that all aside, and I'm going to focus on this one or two strategic strategic decisions, surgical decisions, where you can go in and come out with value.

18:07Jared Aron: And it's a really hard thing to do because in healthcare, you're constantly firefighting. The house is always on fire. There is never a time where the house isn't on fire. But I think that is one of the things that is defining of the next generation of healthcare leader and healthcare operator is the ability to say, what is noise? What is signal? What is value? how do I separate these two things out? And it's possibly the right transition to talk about another thing that we're seeing a lot right now. And this is the healthcare provider who is suddenly also a software developer, which makes absolutely no sense.

18:47Jared Aron: I have no words, which doesn't happen very often. Why that's a problem?

18:56Jared Aron: the idea

19:00Jared Aron: healthcare is a very sensitive place you have patient data you have healthcare records you have money moving people's lives float through healthcare data this is not a productivity app where you upload your shopping list and if for some reason it goes missing or for some reason someone else can read your shopping list the question how bad can it get? The answer is not that bad. In healthcare, the answer is very bad. It's bad. It's bad in the way that if you are building drones and a drone flies into someone's head at full speed, it's bad. You have a problem. And so we hear oftentimes from very entrepreneurial practice leaders, sometimes they're clinical, sometimes they're commercial, they are building their own software.

19:49Jared Aron: And it is absolutely terrifying to hear that. We build software all day. We have an entire team dedicated to building software. These people have spent years of their lives building software. They understand software in a way that a practice leader most likely does not. And the assumption that you can vibe your way to a payment platform for your healthcare practice or to secure patient communications or any other patient operations component is terrifying. Because you've done it, right? You've practically, you are a clinic owner. And then obviously you left the clinic owning world and then you started a software company with your co-founder, Barad.

20:40I see what you're doing. Yes, I did.

20:44Jared Aron: So yes, I used to run clinic. I was very frustrated, very frustrated by the spreadsheets. And even when the software was available, putting it in place, using it correctly, training the team, no one had time for that. So you end up regressing to the lowest common denominator. And the lowest common denominator is emails and Google Sheets and spreadsheets. You just always end up there. On the clinical side of the house, you don't end up there. You've got great systems. On the operational side of the house, everyone's favorite software is Excel. That's just the way that it is. So I've been in that world.

21:20Jared Aron: I have experienced firsthand the frustration of things not being joined up. I've experienced firsthand copying and pasting things from sheet A to sheet B.

21:34when I left clinic and started Coherent I was absolutely certain that that journey needed to

21:42Jared Aron: start with a technical co-founder somebody who had spent many years living and breathing technology who could think about technology at scale who could think about architecture who could think about security who could think about usability all the things that when you use software you don't even see it. You don't even see it. You don't understand it. It was a no-brainer. And so my co-founder, he spent 10 years doing VP architecture security. I don't even know what that means, but he spent 10 years doing it at Morgan Stanley. He was doing cyber risk and threat assessment for billions of dollars at a global scale.

22:22Jared Aron: Then he went over to ActorX, where he did healthcare communications infrastructure for population scale communication. Yeah, I'm not, you're not vibe coding that. That's not how this works. Vibe coding, sure, put up a website, put up a membership page, put up a thank you page. There was a practice leader, he runs, I think, seven dental practices up in Scotland. And he posts, I think something on LinkedIn, he said, oh, wow, we can do so much now we can vibe code. I've just vibe coded my web form. I was like, oh, that's interesting. I went to his website, put in my details, press submit. Didn't work.

22:57Jared Aron: Which is not a criticism. It's just the reality. It's not that easy. It's easy if you want to stand up, thin, low engagement requirement capabilities. No problem. But when you actually need to build something that works in a healthcare environment, it's not vibes. It's not how it works. Especially operations, right? Especially operations everywhere. Clinical, absolutely. Operational, absolutely. You cannot vibe your way through some of these requirements. It is a horrific mistake. We have a healthcare provider that we spoke with who tried to vibe code. I don't know why they would spend their time doing this, but vibe code a CRM to connect with their practice management software.

23:36Jared Aron: They started sending things out to patients that made no sense. People with the wrong names, wrong time, treatments that never actually happened. the downside is too big and the upside is enormous but often out of reach because you just don't know how to do it it's and this was very clear for me i ran clinic i've lived inside those workflows i could specify bullet by bullet exactly what needed to happen and i still couldn't build it i had the deep operational knowledge i still couldn't build it didn't feel confident to build it right now we support the practices that we support go on to support hundreds of thousands of patients there's no vibe coding solution for supporting hundreds of thousands of patients securely safely reliably that is not how this works at least not yet maybe keywords with the reliably safely and securely you can make it look good it's very easy to make it look good you can feel good about it maybe it helps you think creatively, fantastic.

24:33Jared Aron: Healthcare is a reliability market. It is a safety market. It is a redundancy market. The reason that the NHS chooses as a supplier IBM, Microsoft, is not because those products are great. It's because they are reliable. They are durable. That is the only way to create efficiency in healthcare. And all they have the mechanism that's set up specifically to deliver that promise of reliability and security in the longer horizon of time zone. Absolutely. It's not really about I deliver a good piece of software right now. That's functional, that's usable. But things constantly change. I think that's what most people that didn't come from engineering background would miss out because they look at that one tiny little moment.

25:24And assume it's output. Completely. But there's a million variables coming in every the next second, the next minute, the next day or month.

25:32Jared Aron: I think increasingly I spent many years working in hardware, developing medical lasers. I spent many years now in software, building software. And no matter how you look at it, technology is an organism. It evolves. It lives. It's constantly changing. It's not static. And so your thing that works for one minute does not work for one hour, does not work for one year. these are dynamic by virtue of what they are this is why you have support teams because you can't just build it once and release it at some point there will be some issue and the question is what do you do then what do you do then going back to the clinic owners building their own software dynamic that's becoming more and more common these days right and it's not necessarily doesn't need to be a clinic owner, but many professional individuals in their own profession will start vibe coding their own software.

26:27There's nothing wrong with it. But I see that maybe you can elaborate more on this. We discussed this before. I see that as a focus problem. I've seen what is the business. So building, like you've experienced this firsthand and you made the decision to shift into software, you left the clinic world. And in order to focus your attention, working with a team of engineers led by a highly experienced individual to focus on this side of the business but you can't do both simply because it's a complete different type of businesses right and the giving the context of business of a clinic i guess the question is which business are you building this is the right decision to make i completely agree i think that as a healthcare

27:11Jared Aron: provider you signed up to deliver great patient care full stop that's what you signed up to do You signed up to serve, treat, diagnose patients. That's the business. That's the business you're in. Now you're running a business, but the business you're in is high quality patient care. And if you speak to any great healthcare leader, any great group, they will all say, we are in the business of providing great care. Full stop. The mission statement is not provide great care and build great software. That's not the mission statement. That's not the mission statement. The mission statement is we're gonna provide great care.

27:47Jared Aron: We're going to help people who have this problem. We're going to make them better Comma and develop great software. There's no software in your recent statement You shouldn't be spending time doing that. It's not the core business for you core business for you is how do we deliver a more efficient Effective healthcare experience. How do we treat people better? How do we move them to the system better? That is a healthcare provision problem. You need to buy in you need to find the people whose business is is to solve your operational problems. There are many healthcare providers that we work with who try to solve this problem for themselves.

28:22Jared Aron: They get halfway through and that's good enough. You need to be very focused when you're delivering healthcare to patients. I remember when I was running clinic, there was always a distraction. We had one service and we provided one treatment, one. We provided that treatment as well as we could. then someone had an idea to introduce a second treatment we said oh we've got the patient body it's a great time to do second treatment and there is some truth in that you bring patients back you serve them more broadly diversely etc just introducing one more treatment line brought with it a a whole mushroom cloud of complexity different cqc obligations different supplies different supply lines different training different calendar appointment type One, we see practices with 15 different services, 20 different services.

29:16Maybe you can pull that off, but you can't pull that off and also build your own software.

29:22Jared Aron: There's only so many things you can do. More often than not, the problem in running healthcare provider operations efficiently is a problem of focus. It is very hard to optimize 25 things at once. So if you can find a partner, and we often say this to healthcare providers that we work with, we are not doing anything that you're going to do. We're working in a space that you're never going to get to because you're always going to be focused on your core business. Your core business is delivering care. When we come to the party, we say, wonderful to see that you are delivering this really high quality care when patients are in clinic.

30:05Jared Aron: What about when they're not? So you're focused on your in-clinic delivery. We're focused on your out-of-clinic delivery. It's entirely complementary. There is no overlap. You are focused on 10 out of 10 experiences when someone walks through the door. We are focused on helping you deliver a 10 out of 10 experience when someone walks out of the door. These are entirely different ways of looking at your business. And supporting people who are not on-site is just a different business than supporting people who are on-site. One of them is about efficiency, automation, intelligent data. One of them is about service.

30:39Jared Aron: You are a service business. You are not a data business. So when we speak to practices, they'll say, what is the outcome of working? You get to go to bed at night knowing that we provide full coverage engagement from the beginning to the end. Every patient, every time, at the right time. If they ask not to be contacted, no problem. That's not an issue. At least we know. Our job is to follow up and engage with every patient all across the journey. And when you do that, you start discovering this patient actually wasn't happy with their experience. Oh, okay. We need to speak to that practitioner.

31:18Jared Aron: Hold on a minute. This patient says there's a clinical concern. They're in pain. Why didn't we know about that? And so there's this overlap, serving patients out of the clinic, supporting patients in the clinic, but they are not the same thing. There's interaction between them. One of them is inpatient service. One of them is outpatient service. You need a partner. You need a way of getting full coverage engagement. I spoke with a group this morning up in Ireland, and it's led by a very thoughtful, very patient-centered, very commercial clinic leader, very clear on his business model, really a stand-up guy.

31:50Jared Aron: Not building their own software. Definitely not building their own software yet. Very clear on his core businesses. And we got on the call and said, listen, we'd never spoken before. He said, listen, we're reaching out because these are all of my new patients. Show me the numbers. These are all my new patients as of the last three months, 614, 615, whatever the number was, just over 600. We're three months in and only 200 of them or just over 200 of them have the next appointment. Two thirds of what's coming through the door is leaving in three months. That is not a problem that you in-house know how to solve.

32:23Jared Aron: Sure, there's training, there's in-clinic room delivery, there's treatment plan explanation. There's a lot you can do to tighten that in clinic. But when those people walk out the door, you don't have the team, you don't have the tech, you don't have the know-how to monitor, engage, support, stay in touch with. These are fundamentally different problems. So I think what's interesting right now is we're at this moment in healthcare provider operations, particularly in private healthcare, where competition is going up. Competition is going through the roof, almost everywhere. You run a dental practice, down the block, there's another dental practice.

32:54Jared Aron: And by the way, they've got more Instagram followers and much more marketing budget. You are in competition with people down the block. And then when patients go home, you're in competition with Netflix, with meta, with attention grabbing machines that you simply can't compete with. And so your patients are not your patients. There's this really interesting example. We had a patient recently who wrote into us saying, they of course, we work on behalf of the practice. They write into the practice, we see the communication. Patient said, I've moved out of the area. I'm no longer a patient, but I just want to give you props for your great follow-up.

33:31Jared Aron: I work with a lot of businesses. I work with a lot of brands who grossly underestimate the importance of follow-up. Like we have the message, right? They don't know it's us, but we have the message. And you know something's going right when your patient who's moved away, who's no longer a patient, writes into you and says, I just wanted to give you props for this thing. And that is the difference between a patient that stays and a patient that goes. It's a patient who feels that warmth, that support, that ongoing nurture, that ongoing point of access back into the clinic. That is fundamentally the difference between I'm shredding water and I'm filling the bucket.

34:08Jared Aron: These are very different experiences. So that sounds like coherent engage. That's coherent engage. Let's talk about coherent engage. What does it do? Why is it different from a CRM? Or why is it better than a CRM? Coherent engage is an insurance policy that no patient falls through the crack. That's what you're buying. A new inquiry doesn't fall through the cracks. An initial assessment that doesn't show up doesn't fall through the cracks. A patient who comes in, has three treatments, cancels their fourth, doesn't fall through the cracks. A patient who hasn't been in for three months doesn't fall through the cracks.

34:45Patients falling through the cracks, losing patients, that is an operational problem.

34:51Jared Aron: It's a technology problem. It's a data problem. And when we speak with practices that are interested in coherent engage, they want assurances. They want to know that when their front of house is off sick, when someone's on holiday, when a practitioner has a bad day, when a practitioner feels lazy, when they don't want to make the extra phone call, when the patient doesn't see the email, the millions and millions of reasons that patients fall through the cracks, they want insurance. That's not going to happen. The consequence of doing that is, yes, patients come back. Yes, you get some feedback that you might otherwise have.

35:27Jared Aron: Yes, you get some staff efficiency. But what you're buying is certainty. Certainty that every patient gets the next point of communication, makes them feel supported, shows up because they have that support in that relationship with the practice. That's what you're getting in insurance policy. Now, there are obviously features that go into that. Yes, there's data mapping. Yes, there's data cleansing. Yes, there's outreach. Yes, there's response handling. Yes, it's SOP compliant with how you work. You want your initial assessment booked into your calendar in the color pink? No problem. We do it in pink.

36:00Jared Aron: You want it in the color green? No problem. We do it in green. You want 15 minutes after your yellow appointment, but 20 minutes before your blue appointment? No problem. All of that is execution. And it's that execution that makes the machine run faster. It makes your machine as a clinic owner run faster. It's an insurance policy. That's ultimately what you're buying. Now, the difference between a CRM and working with Coherent Engage, using the Coherent Engage platform, many things, two that stand out. I believe four. Two that stand out. The first thing is, who's doing it? Are you doing it? Or are we doing it?

36:41Jared Aron: So when you go out and you buy a CRM, you go out and you buy HubSpot, you go out and you buy Pipedrive, Salesforce, you spend a lot of time trying to set stuff up. More often than not, you don't set it up correctly. They don't care. You're paying the subscription. What's the problem? They're getting their money. They're happy. You're locked in. It's all good. So one problem with the CRM is that you're not using it correctly. The second problem with the CRM, especially generic CRM, people that don't specialize in healthcare, is that there's absolutely no alignment between the non-clinical and the clinical journey.

37:16Jared Aron: We have a practice that we spoke with that uses Practice Hub, which is a MSK chiropractic management software, very good, and HubSpot. You'd think they got everything covered. Not even close. He says by his own admission, two systems don't talk to each other. Patient cancels, HubSpot has no idea. HubSpot books in a patient, Practice Hub has no idea. We've got another practice that we spoke to that uses Zoho CRM and Semble. Nice practice software, modern, good tool. Zoho doesn't talk to Semble, Semble doesn't talk to Zoho. Patient books in, they're updating it in two places. So who's setting it up?

37:54Jared Aron: That is one big problem. Second big problem is, does it actually fit your journey? are you actually building a patient engagement program that makes sense in the context of the carrier delivering or are you just slapping on random communication because you think you need to send stuff out these are the two biggest problems the third one which is harder to understand but i think probably where the magic happens is data data when you set up a practice management software you set it up in a way that you want when you set up a crm you try and set it up in the way that you want. You have absolutely no idea what works.

38:28Jared Aron: You don't know what you should say to people, when you should say to people, how you should say to people. You have no idea. You're best guessing. You're saying, oh yeah, I think I should send this email out at 11 a.m. on a Monday. I think I should send this SMS out at 4 p.m. on a Thursday. You've got absolutely no idea. You are totally shooting in the dark. And so that lack of knowledge, that lack of context, implies that you're getting it wrong. Because unless you are really good at performance and engagement marketing, unless you have a really strong background in patient communication, you are missing enormous parts of the opportunity and support space for your patient body.

39:09Jared Aron: So I think those are really the three differences. We often speak to practices that say, oh, I use Go High Level or I use a CRM. We say, great, hopefully after three months of working together, you can get rid of it. Get rid of it? Oh, I don't have a CRM. You do have a CRM. CRM done for you. You get all the data. You get all the insight. We do all the correspondence, do the outreach. That is coherent and engaged. CRM done for you. There's no weight on your shoulders. You don't have to worry about setting up automation. That's not what, that's not, go back to what I was saying earlier. It's not your core business.

39:39Jared Aron: How do you know as a healthcare practice what's working? You send out lifecycle marketing emails once a month. You look at open rates, you think, oh, we're doing a good job. That's not good enough. If that were good enough, then when we reach out to a patient, we wouldn't be getting back three paragraphs of information about how they were upset with their last appointment. If your communication was working with patients, then we would not come in and get feedback and concerns and bookings, by the way. We would come in, we would set up, we would do something, nothing would happen. If your thing was working, nothing would happen.

40:14Jared Aron: It's not the case. You get patients who reactivate, who re-engage, who share complaints, who share concerns, because they're being spoken to like people. And I think fundamentally this is the thing that is different about coherent engagement CRM. If you want to speak to your patients like people and not like numbers, you need different tooling. You need different infrastructure. And I think that's often what we find, is that healthcare providers who want to speak to their patients like people, not like charts, not like numbers, not like journey maps. They're looking for something different. And this is where they find it.

40:48So this sounds like the agentic CRM or patient engagement done for you.

40:54Jared Aron: Your choice. Agentic CRM, patient engagement done for you. It's interesting right now, if you look at the broader CRM category, for a long time, it's been the sales forces, the HubSpots. In the last five years, arguably in the last 25 months, there are probably a hundred new challenger agentic CRMs. We use one of them here at Coherent, right? We use our own CRM, not our CRM. We use an agentic CRM and it's a great tool. There's a new wave of agentic CRM, of customer relationship management, in our case, patient relationship management. There's a new wave. It's happening right now. It's happening in the horizontal market.

41:34Jared Aron: It's happening in general business. And as with all things in healthcare, at some point it will make its way to healthcare in 25 years when the next thing is already here. So we took a decision early on that, hey, this is happening everywhere else. We're going to bring it here fast, early. We want to bring a genetic CRM, patient engagement done for you, intelligent, patient relationship intelligence, not patient relationship management, patient relationship magic, not patient relationship management. We're trying to bring that to healthcare providers. And I think one of the biggest things that needs to change in the mindset is, hold on, I don't get a login in the same way.

42:15Jared Aron: I don't have user seats. I don't have to go in and there's a behavior change that comes with this. And I think that's an exciting thing because when behaviors change, things usually move forward, which is very different than I got 20 minutes left on my day. I get 40 minutes left on my day. the behavior change there is I've got 20 minutes to breathe, eat, walk, all important, but not fundamentally changing the way practices operate. And I think now we're at that inflection moment because technology has made it possible. Talk about the different programs, aged leads, cancellation, post-consultation, recall.

42:54Jared Aron: Yeah. I'm going to see if I can hit 15 places that you're losing patients. I'll try to go top. I'll go back of the journey up to the front of the journey. 15 places that you're losing patients. Here we go. Longstanding patients that haven't been in for a while and have no next appointment. You might call that patient recall. You might call that patient retention. So let's say they haven't been in for four months, done of next appointment. Cool. That's one.

43:20Jared Aron: Patients who don't attend. DNA, non-attendance event. Patients who cancel. don't rebook an appointment.

43:31Jared Aron: An initial assessment, consultation of some kind that books but never attends. An initial consultation or assessment that books and attends but then does not rebook or continue with their treatment plan. A new inquiry that expresses interest in booking but doesn't book. A new inquiry that reaches out does not express interest in booking and still doesn't book. A patient who has completed a course of treatment of some kind has expressed concerns beyond that treatment and who has not been supported or activated to continue with their next treatment. An insured patient using insured billing or some kind of private medical insurance who has a certain number of appointments left in their agreed course of support with the insurer who has not claimed them.

44:33A patient who has come in, visited the clinic, had a consultation,

44:38Jared Aron: started a treatment program, but not completed a pre-agreed treatment program. that's 10 i'm not we haven't even got started yet i think inside of each of those journeys each of those that's 10 programs 10 programs for patient retention plugging the leaky bucket 10 programs inside of each of those there are probably five variations because when patients reach the end of their treatment journey they don't all reach the end of the same treatment journey they reach the end of a surgical pathway a non-surgical pathway an intervention intervention pathway, a non-intervention pathway, a diagnostic pathway, a non-diagnostic pathway, there are probably at least five general categories.

45:19Jared Aron: It's almost like a tree. And then those five each have five and those five each have five. So now if you're a private healthcare system, if you're a hospital, you probably have 10 ,000 unique patient journeys. You've got blood work. You've got 10 ,000 patient journeys. And supporting patients non-clinically through each of those journeys reliably reliably that isn't that reliably that is not that's not hire one more patient coordinator that's not my front of house with my staff will do it i've got a great front desk team okay can your front desk team segment data into 450 different patient journeys and communicate with each of those patients in a different way that's cool if they can i've no judgment.

46:07Jared Aron: But reliably supporting that variability, that incredible volume and diversity of patient journeys is a technology problem and it's a data problem. It's not a headcount problem, not a staff problem. And I think when we look at patients disengaging, this is where the problem shows up. And you know you have the problem very quickly. We know you have the problem very quickly because we just ask one or two questions. And if you can't give clear numbers, we know you have the problem. How many people inquired last month at the practice? Oh, we had 160 new starters. Okay, wait, how many people inquired?

46:41Jared Aron: I'm not really sure. You have the problem. Because it wasn't 160. It was not 160. You didn't get 160 inquiries and 160 new starters. It was not 160. And healthcare practices, it's not like shopping online. It's not like e-commerce shopping where you browse a website. You reach out because you have intent. And that intent is what drives the patient journey. Tell me who are the top three famous people whose work had an impact on you and what kind of impact do they have? Famous people? Yes. I guess I live under a rock as it comes to media. I'm influenced by a lot of stuff but I will tell you that I can tell you about people that I really respect.

47:24Jared Aron: People who I think understand, have unique perspectives, who understand the world in a way. Travis is back. What's your comment? I think it's awesome. Why? I mean, give a bit of context. So I don't look at, yeah, Travis is the founder of Uber. I've used Uber. I don't know him personally. And I know that people have many opinions, but I have nothing to say. I have no first party information about Travis. But what I do know is that the velocity and the pace and the focus that drove the Uber engine, putting aside problems, et cetera, velocity, pace, and focus were very widely recognized. And as he said, now he's back.

48:00Jared Aron: And I remember there's that scene in, I think it's one of the Batman movies, where Batman jumps off the roof and then someone sees it and says, he's back. And there was someone who was doing a parody on that I saw earlier today because Travis just announced a new business. And I think there's an excitement around that because people know about the intensity, the focus, the pace, the ability to sink and operate at that scale and to be back and doing it again. Without, there's no financial need to, presumably, is very cool. and I think for me to see that I think it's incredibly motivating to say actually the reason to get up in the morning is to solve problems and when you have that motivation it's going to carry you forward into your next thing into your next thing into the next problem even if you don't need to work as I'm sure is the case for him he's made a decision to go out and solve a big hairy problem more big hairy problems he's going to solve more big hairy problems now I hope that, again, I don't have any first-party information, but I hope that some of the negative things that surrounded the first experience, or at least the reported negative things, whether they're true or not, don't necessarily carry through to the second one, because I think that was unfortunate.

49:13Jared Aron: But I think ultimately the energy, the focus, the pace, the innovation that comes from that kind of delivery is really exciting. And I think it sets the bar for the pace of ambition that we should all be striving to, right? I think that's one thing that I think is very exciting. So I think that's, I don't know if he's someone who's directly influenced me, but I think I certainly respect and see the energy that comes from that kind of focus. So that's, that I think is definitely one of them. There's a, there's a gentleman again, I don't know him. So it's probably not a good thing that a lot of these people I don't actually know.

49:41Jared Aron: There's a gentleman that, who is the director of three documentaries, maybe he's on other stuff as well, but I've seen all three of them, Chasing Ice, Chasing Coral, and The Social Dilemma, all of which use documentary telling and storytelling to surface these very real problems. one around coral bleaching, one around ice cap and iceberg recession, and then the other one around social media addiction. And I think the storytelling is incredible. I think it's very captivating, but also I think it's such an interesting way and a powerful way to align people around a problem. Because I think oftentimes you have causes that don't gather the necessary momentum, the necessary traction, because the way in which the problem or the cause is framed is not suitably compelling.

50:21Jared Aron: And I think when you look at the way he or the director, the team, tells the story, sets the stage, it's very easy to connect with it. I don't really know much about coral reef bleaching, but after you see the documentary, suddenly it becomes a thing that you care about. And actually, after I saw the film, I went out and invested in a business called Seabin that does ocean waste collection pollution because I found it so motivated that this is such an important thing. I should be part of this. And obviously, I'd love to live on the beach at some point, but it's very captivating. So I think it's another example, energy, focus, and intensity, one source of North starring.

50:55Jared Aron: Another one is how do you think about problems and tell the story of those problems in a way that's very captivating? And I think healthcare has that problem, actually. The clinical problem is very exciting. People are very excited about the biology, the cure cancer, and rightly so, it's very exciting. But if there's anything we can learn from the way that the social dilemma or, I mean, how exciting can it be to sit there and watch an ice cap recede. Very exciting, I have to tell you. And I think that the healthcare operations problem, it has this problem. The problem is that it's boring and it's ugly.

51:27Jared Aron: And because it's boring and ugly, nobody really cares. Nobody goes out and solves that problem. It's not exciting enough. Actually, it's hugely exciting because healthcare is a logistics problem first and foremost. And if you solve that problem, then you unlock access to care in a way that doesn't previously exist. So I think that's really interesting and exciting. The third one is a researcher out of Oxford. University, who is a philosopher. And he talks about, I suppose it's all three of them, man, it's not by design, but he talks about this hypothesis called the vulnerable world hypothesis.

51:57Jared Aron: And basically what he means in the vulnerable world hypothesis is that as humankind, you constantly innovate, you constantly create things. And every now and then you reach into a big urn, the jug, whatever it is, and you pull out innovation. And you say, wow, look at this innovation. The problem is that thing you're taking out, the thing that comes out of that urn, it's either going to be a black ball or it's going to be a white ball. And if it's a white ball, it has phenomenal impact. It has positive impact in the world. It moves things forward. And if it's a black ball, it can do all kinds of bad things.

52:34Jared Aron: And the issue is that you don't know until you take it out. You don't actually know what it is until it's out in your hand. And the problem, of course, is that once it's in your hand, you cannot put it back inside. It's now out. It doesn't fit back in the bottle. So now that it's out, what do you do about it? And I think it's such an interesting way of thinking about innovation. And it's, again, been very informative and very formative in terms of how we think about stuff at Coherent, because we are very happy, and we've taken the decision to go slow to go fast. We've taken a decision to understand deeply what reliability and safety look like in our context, in a healthcare context.

53:10Jared Aron: And if that means we're going to be slightly less efficient, if that means we're going to be a little bit more boring, if that means we're going to be slightly counter to AI-ification of everything, we're okay with that. And I think for us, the reason that we're okay with that is because we are very aware of the fact that this thing that has just come out of the urn will no doubt have a lot of white ball characteristics and will have a lot of black ball characteristics. And we would just like to be sure about which one it is and how it presents before we let it go on health care and on our population's most vulnerable people.

53:46Jared Aron: And so we've taken the decision to approach it differently. Now, time will tell if that was the right decision. It may have been a terrible decision, but I think it's a very interesting way to look at what's happening right now. Yes, it's exciting. And also, yes, let's be very serious and very sure of what it is that we've just taken out of the box because we are playing around with this dark magic every day. And I have to tell you, for a team of engineers, we have high confidence in some things and we've got less confidence in other things. And if people are telling you differently, I'd love to meet them because they're probably lying.

54:20Jared Aron: Or they have figured out something that we've not yet figured out, and that's fine as well, but it's not all a party. And I think that's very much what this philosopher argues. He argues that it's exciting, but be clear about what it is. Know what it is. Do your work to figure out what it is. Social media intersecting the two inspirations. Social media is a perfect example. It came out of the bottle. Looked exciting. Everybody got on board. Ten years later, we've got a mental health crisis in young people. Nobody knew it was coming. We didn't stop and say, hold on. Now you've got businesses that are building screen time moderators because you can't get kids away from their phones.

54:56Jared Aron: You're trying to build the fix to a problem you didn't have. It would be wonderful if we could not drop the ball on this one. as a society. It would be wonderful if we could apply a little bit of forward thinking to say, maybe if we just put a little bit extra here and a little bit extra here, then we can do a much better job of making sure the color of this thing is what we want it to be, that the outcome is what we want it to be, and not that we're chasing our tails trying to fix a problem that we didn't actually have in the first place.