The Earned Patient: 60 Minutes Door-to-Door Equals 90 NPS

David, what's the biggest thing you're doing in your job?

The way we're changing healthcare and engaging with the consumer is the best part.

Hi, my name's Adam Durrell and I'm the host of the Account Experience podcast. This week we're gonna dive into the CX customer experience of the healthcare business, specifically in the urgent care world. And there's gonna be nobody more qualified than the person that we've got on the show today to talk about this. And if you've been here, you'll know that in every episode, I like to catch up in inspiring industry leaders or thinkers who are sharing best practices and their tips to help you develop your own account experience program. And you know me, I love detail, so I like to grill people on this as well. I'm also father of four, I'm a founder, and I'm fanatically interested in what makes human relationships work. And I love anything that really helps the quality of business to business relationships. Today, I'm delighted to be speaking with David Apple, who's the Chief Marketing Officer of Intuitive Health. David's role is he's there to lead the company's marketing, brand strategies and especially the customer experience and that whole thing around patient communication, which, as he'll explain, is so important. And as we go into it, David's going to talk a little more about Intuitive Health. So we're going to dive in right now and say hello to David and find out what he's got for us.

Good morning, Adam.

Hey, it's great to see you, David. Thanks for joining us today. I really appreciate it. Morning for you, afternoon for me. I'm in Amsterdam. You're in Texas, right?

That's right, yes, sir.

Oh, it's great. Hey, listen, so what I really want to dive into is I want you to really dive in about the company, about Intuitive Health. But first of all, why don't you just talk about yourself a little bit? How did you get to the role that you're in?

It was just a miracle, that's all. A lot of begging and a lot of pleases. Right. So, no, this has been such a great evolution for me personally and for the company. I know I spent my career really wanting to be on the cusp of what's new, what's exciting, who are the disruptors partner with those visionaries. And I've been very blessed and lucky to be really a part of some really great visionaries, like Dr. Woody, who's founded Intuitive Health and in some previous roles as well. So my background is Very digital, the digital consumer experience. I spent a lot of time in the mobile space, the evolution of the growth of mobile and how that influences the shopper decisions, and then switched over to healthcare because I saw some great opportunity as the healthcare consumer has certainly changed habits over the last decade and 15 years on how they choose providers, especially in the United States, because we have a very different system here in the United States. How they choose providers, how they judge healthcare, the outcome. And that has all really, really progressed. Probably came to a head, as it did in a lot of places around the world during COVID Yeah, for sure. And here we are in a dynamically different healthcare consumer world that is today. So my personal involvement is really how do we connect that consumer with that experience? What are they seeing, how are they engaging, how are they booking? Even the mechanics of the healthcare experiences, you know, how they're booking, how they're being billed and all the attributes of really the traditional consumer, the modern consumer digital experience wrapped up into healthcare.

So that's a great way into it. So it's the whole digital experience really putting the consumer first on that one. So let's talk a little bit about the company, about Intuitive health, because the way I look at it is you guys are already disrupting healthcare. So especially perhaps if you can help non us folks listen, like me, you know, really understand what the urgent care business is about, where it fits into the context of healthcare.

Yeah, it is very interesting. It's been a remarkable evolution in the United States to this retail health and what retail health is. It's exactly that. It's essentially prior to this growth, you had a big hospital in the center of town and then you had your primary care physician and your specialist kind of scattered around throughout town and everything involved, either you got picked up in an ambulance if you were having an emergency, or you had a schedule appointment with a very specific specialist. That became the American consumer probably over consumes healthcare a little bit. And that became a very crowded space, very hard to get care, very hard to schedule. And an appointment and the billing is very complex the way insurance companies bill and accept payment. So it really, it was a tough place to navigate as a patient or a consumer.

Yeah.

In the early 2000s, this concept of the smaller open access health care facility came into play and they, we call them urgent cares. We would call them freestanding emergency rooms. And that allowed patients to not make an appointment, not have any prerequisites. They could just simply open the door, walk in, tell them what was wrong and get care. Now there are Certain levels. There was a. The lower level, which is the urgent care, which is your common kind of household accidents and flus and colds and things along those lines. And then there was the higher acuity, as we call it, or higher caseload, which would be an emergency room, but smaller. So, you know, you wouldn't go into the big hospital downtown. You could get emergency level services in your community. So those started to show up on the map. The problem was consumers said, do I really get good care in that small facility? I'm kind of more confident going downtown to the big hospital with the gentlemen and the lady doctors and physicians in white coats and labs and things going on. There was a certain level of confidence with that. So it took. It took a while for this retail health care concept to get the level of confidence from the consumer to really progress.

Okay, that's a great way to think about that. So you're already thinking about the patient first, or almost as a retail outlet first, right? Well, we'll get into that a little bit later on, but let's again set the scene for the type of business you're in.

So.

So the, the accidents and the emergencies that you're dealing with, are anything up to cuts and bruises? What about a broken arm or something like that? Is that typically dealt with or do you go to hospital for that?

Absolutely. So. And I probably left out the part where intuitive plays and all this because it's really.

Don't worry.

You did ask that question. So I apologize. But in this industry was growing, our founder, a very accomplished Emergency room physician, Dr. Woody, said, we can take advantage of this growth and treat patients better. We can give them a better experience. Which was. Nobody was talking about Adam in those days. Nobody was talking about, hey, as a patient, this is a terrible experience, both in the retail side and even in the big healthcare side. It took you a very long time to get through the front door and come out the back door. You know, a lot of times those urgent cares that were evolving didn't have the right level of physician or care team to give you care. Even though they said, walk through the front door, you would sit in a chair for three hours before you were or you were seen. There was a lot of things wrong. So here comes intuitive health in 2008 and says, we're going to change the experience. We are going to center our care around what the consumer and the patient wants. As every visionary has heard, everybody said, that's a stupid idea, right? It's a stupid idea because you're going to see a patient, you're going to treat them quickly, fairly, with a smile. You're going to, you're going to say things like, we're happy to see you, we're going to take good care of you, please and thank you. Right. All those things that are kind of modeled now as the most important things to say. We were doing all those things in 2008. And then most importantly, Adam, at the basis, at the core of our experience was we were going to bill the patient fairly, meaning if they were only coming in for a cold or they were only coming in for a slight sprain or a banged finger, we were going to charge them urgent care level rate. If they were higher level, we had them qualified staff, we had emergency room equipment and staff, and we were going to charge them emergency room. Why is that a big deal for your audience outside of the United States? That probably doesn't make much sense. In the United States, that's a delta of thousands and thousands of dollars of cost. And what's happening is, is you go into the big hospital downtown and you said, oh my, my chest hurts or my stomach hurts. And I want to be sure you go down there, it's nothing, you know, it's too many tacos or, you know, too many beers the night before and they just send you home with a, with an antacid. You're still getting billed thousands of dollars for that. In our experience, you're getting billed fairly.

Aha.

That was the big dynamic change and why intuitive really took off. And that was the stupid idea that everybody, that everybody believed that we were going to fail because we were doing that.

And I think this is crucial because for those who've not attained, who've not been in the US Healthcare system, that delta is huge, isn't it? And many patients that you see are uninsured. So let's just touch on that for a second, just so people can really understand this. There's a large amount of patients that you've got in the US who don't carry insurance. So they can't afford health care, right?

Yeah. There's two parts to that. Right. So there's not, it's not only necessarily uninsured versus insured. The, because of our large consumption of health care services in the United States, even the insured are paying a lot of money to have that insurance. And their employers who are providing that insurance are paying more than they've ever paid in decades previous because of the large consumption of healthcare. And then you have essentially the cash payer or the uninsured who can't afford insurance. So if you think about that same scenario where you're not sure, you're nervous about your, you know, you're nervous about your, you know, what's going on, your chest hurts, whatever the, whatever the case is, and you go into an emergency room that has no scenario except emergency room billing and you're paying cash for it, you could be paying 3, 4, $5,000 in cash for an antacid. Right. Essentially at the end of the day, you walk into an intuitive facility and that same scenario played out, you're going to get billed at the much lower urgent care rate. And beyond that, which is just low hundreds, very low hundreds. But beyond that we have programs and consumer specific, you know, ideation that says we're going to help you with that. Yeah, right. You don't have to shell this out right now. We have programs, we have a payment program, we even have some temporary insurance programs that helps those cash payers through that, through that experience more efficiently. So again, it's all about the consumer for us. Sits up here.

Yeah, right.

We're working for the, we're working for the patient versus working for the physician, working for the insurance. It's really, it's really dynamic.

Thank you so much for giving that clarity. And you know, I've also experienced emergency care rooms in the US and, but I speak from the UK where my mother lives. She was in A and E for 12 hours recently and terrible, terrible experience. So what I think is so powerful about this, David, and why I love you explaining this is it's because it's applicable to other healthcare systems outside the US I'm absolutely sure about this, but let's just ground ourselves. The size of your business is you've grown. So how many emergency rooms do you have and how are you geographically spread? Can you just give a context of the business?

Yeah, sure. So this terrible idea started with one facility in North Texas, quickly grew, right, because consumers said this is a great idea, as we anticipated they would, and then opened up another facility and another fast growing part of North Texas. And if you don't know the economics of Texas would be the fifth largest country in the world on its own. So it's a very fast growing part of the United States. So these facilities were perfectly poised to the two facilities. Then we got an equity backer, somebody put a significant amount of resources behind the company because they believed in the model. And then that, that quickly allowed us to expand. So right now we have 30 of these facilities open coast to coast. We have another 70 under contract or under construction. We in those early days in 2008, we saw just a couple thousand patients and in 2022 we saw almost 500,000 patients. This year we'll see almost three quarters of a million patients. Really the way we look at it is our goal is to see a million patients a year because when we see a million patients, we're saving hundreds of millions of dollars to the consumer for unnecessary emergency room visits. We're saving hundreds of thousands of minutes, unnecessary minutes of that door to door time which we can talk about that experience, which is again part of our IP and core to our experience. And we're providing excellent health care jobs and a really wonderful culture centric healthcare experience for the employees, which unfortunately has not been a mainstay of the healthcare world in the United States where it's a, it's a challenged, you know, work environment. So our growth really spearheads a lot of really core components to health care. And it really is, you know, I don't know if this word is, is probably overused and maybe died out like this going in 2009, but we've become a disruptor for sure. You know, we are definitely doing things different than the typical, you know, US based healthcare company or health system.

Well, I think that's great. I mean that's, first of all, it's a fantastic overview of what you're doing and the company's doing. So let's dive into your experience program, which, you know, is really what we're here for. We'd love you to share as much as you can about this, give an outline of how you are understanding patient feedback and how you bring that into the business.

Yeah, absolutely. So if you rewind to 2008 when we again, when the dumb idea became a reality. Right. And everyone said this wasn't going to work, it wasn't going to work because healthcare does not ask patients for feedback. They typically, I don't say they don't care, but it's never been part of the experience. From day one. We still have the feedback from the very first patient. You know, what did you like? What didn't you like? You know, just really simple feedback. Not nps, not anything, you know, hey, how was that? We have no idea this is going to work. You tell us. Well, that was great because you're right here, you're in a great location. You saw me and you know, I was in and out in 30 minutes and I'm on my way. We knew we were onto something really right from that moment because that was the goal. The goal was to say, for the patient to walk through and say, this is different. I feel different. This is the way it's supposed to be. We've been asking for this forever. Why can't it be this simple? So it's obviously, it's not simple. It's very complex. Right? You know, healthcare is complex. We're saving lives. And this is a very important experience. This is not Chick Fil A. This is not a hamburger. This is. People are sick, they're having a terrible day.

Yeah.

Nobody comes into the, you know, the emergency room and says, hey, great to see everybody. You know, my, my appendix is bursting. You know, it is a tough experience. So in reality, we, we said, we're starting with an unsatisfied consumer. We're starting with a upset person. We have every opportunity to complete, completely change the perception of what's going to happen. Because in the United States, the healthcare consumer has a poor perception of the healthcare experience. 100%. We know. We don't even have to survey patients know that. We know that they have a poor anticipated outcome going like, oh, I'm going to sit here for four hours. I mean, this is going to be terrible.

Yeah, okay. Yeah.

So that's. Let's take that to our advantage. Let's say, let's look at what is broken. Okay? What was broken in healthcare, and probably still is, was the relationship between the physician and the nurse and the front office. They were not teams. Sometimes they're owned by different companies, they have different leadership, they have different objectives. So a patient walks in, meets with somebody that does not care about the outcome. Then they meet the nurse who doesn't care about what the physician is going to do, and then they meet the physician who doesn't care about what the front office or the nurse provided previously. They're on their own schedules. Well, add that up. You have a patient that's been going through the care process for two, three, four, five hours, right. And nobody seems to care. We fix that right off the bat. We said this is a journey. The journey is cyclical. Every single touch point matters. Every single touch point matters. The cleanliness of the parking lot. Right. The landscaping, the. Every single thing matters in these facilities. You walk in the facility, the front office person, the receptionist, is as important as the physician. They're smiling, they're welcoming. There's no glass partitions. They're not dressed in, you know, lab coats. They are welcoming. We're glad you're here. We're going to take good care of you today. And then the nurse and the physician work side by side to dictate care. These nurses are professionals, right? They've gone to. They know what to do. Why do they have to wait? We always say, why are they waiting for the physician? If, Adam, you come in with the flu.

Yeah.

You have all the flu symptoms. It's flu season. Why can't the nurse start flu treatment?

Right.

And then by the time the doctor gets there, the doctor has everything ready to go. They talk a little bit about your symptoms, maybe some unique features of your health history that could make your flu worse or better, and then you're on your way. And Adam, you walk out and go, oh, I can still go back to work. I've only been here for 45 minutes. Right. I'm on my way. I have instructions, I have my meds. I'm on my way to feeling better faster. Right. Was one of our, you know, one of our taglines. And all of a sudden people started saying, that was easy. Why does it have to be so complex? So that's how we really encompass. And that's on the lower acuity, the flus and the cold, and that's on the broken legs. You know, heart attack, stroke, everything has this cyclical, very efficient process within our facility.

I. I'm going to pick you up on that. One of the things I. I'm hearing from you is that giving people back their day and time is really important. Right. So is that a metric that you're measuring the time and what's, you know, what are the important points on that?

We've been doing this now for over 15 years, and we understand the metrics. We have data from the time it takes you to walk through the front door to reception, from reception to physician. All that adds up to a very specific metric, door to door time. And how door to door time impacts the entire world is if you think about what we backing up a little bit, if you think about where we build these facilities. Right? Yeah, we're not built. We're building them in places where the consumer already gets their trade, right? So next to their grocery stores, next to their schools, right. It's right where they already have this perception of good experiences. Right. They have their favorite grocer. They have all this. So they're. They're right there in that. That experience. So we have to match. We have to match that area. Right. You can't walk into the grocery store or know where everything is in and out, and then all of a sudden have to spend 12 hours at this place. So, and you look at the common consumer these days, the typical consumer these days, it's time and it's money.

Yeah.

Right. So we, we realize now, looking at this data, that we have hundreds and hundreds of thousands, almost a million pieces of feedback since we started. The most commonality of the good experience is these guys care. And they were efficient. They were efficient. They were efficient. I mean if we had to build out one of those word matrix, but the most important word from our feedback, efficiency would be big. Yeah, right. Friendliness would be big. Right. And that would be, those would be the two core components. So that door to door time matters immensely in our feedback score. And if you, and if you, and we've all. We've culminated that. Right. So we said, you know, where you guys have come in is we know we're doing a better job than health care as a whole.

Yeah.

How do we start measuring? And we did not want to go. Health care has a lot of very big kind of monopolies in the feedback world. And the reason those, and the reason they have become monopolies and they become big is because they feed certain, you know, oversight committees and things along those lines like safety, cleanliness and some other core components. So they address that market, but it does not address efficiently the real time consumer feedback. My big push, my big push early on was I said, hey, we're, we are modeling our experience after a retail experience, a friendly retail experience. Why are we measuring as a retailer and I've had experience with MPS going way back, and I said, I really, truly believe that we can implement this at a larger scale in our facilities. It is definitely going to be a learning curve for physicians and clinical teams to get this level of measurement on a regular basis and this consistent. But it really will be able to tell us on a daily basis, are we meeting the benchmarks in those goals that the consumer wants? Are we slipping? Where can we improve? You know, so our culture has really been on the, you know, been fundamentally based on continuous improvement. And that's daily improvement. That's not. Oh, let's, let's look at the last six months and then see where we can improve for the next six months. I'm saying here's how we did on Tuesday. Yeah, we're improving on Wednesday, we're fixing this on Thursday. Right. This is a, a high volume continuum feedback. And it now in this day and age here, 23, you know, it's the expectation physicians and nurses are coming to our team because they want this feedback. They know they're doing good in their, in their jobs. Now they get to be, now they get this measurement and they get to prove their worth.

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Let's get crunchy on that for a second because you made a beautiful case about how you're different to the old style hospital with those monolithic which I'm sure there's plenty of good reasons why they're where they're like that and there's some probably great treatment outcomes on that. But you are very much focused on the consumer and if I'm, if I'm right in thinking about this, most healthcare institutions in the US are measured on sort of an annual basis paper based survey. I don't know, I think it's a fairly small amount of patients. But you get the score on that. I'm not going to criticize that. But your approach is really about the real time feedback at scale. So let's dive into that. For all the geeks who are on this call that love MPS and the details tell us a little bit about how you measure it. When do you measure a patient? What vector do you use to do it? And I'm going to get, I'm going to ask you some numbers and metrics if you're prepared to do it. David but you say you're doing survey. Does everybody get a survey? And if so when really get. Let's get Dive into this.

Yeah, I love, I love teaching out on this stuff. So we intend to survey 100 of our patients every single. Okay, so what patient. Let's just take a, let's take a day, let's take a Monday. So on a Monday we see 5,000 patients. Okay. Overnight, the data from those patient visits goes into our system.

Yeah.

It's cleaned up, whatever needs to happen. And then the next day at the right hour, all those patients are sent. Right now we're only using email push for a lot of reasons. Healthcare has a lot of rules and things along those lines and we're working towards progressing some other channels, but right now we're doing email. And we email 100 of those patients from the previous day.

Yeah.

And we closely monitor the level of feedback. But we get about 20 to 25% response rate from those. From those 5,000.

I just 20% or 25% response from the email send.

That's, that's right.

That's really good.

Yeah, that's right. And, and it's got, you know, it's, it was probably higher in the beginning and then it's gone down a little bit because you know, people are over surveyed these days. Everywhere they go they get a survey.

And it's still amazing. That's an amazing number. Yeah.

But the health care experience is pretty important to people. Yeah. Right. And so we get about 25% response. All that data immediately hits our customer gauge system.

Yeah.

All of our clinical leaders, front office leaders, everybody who is in charge of leading teams to create better experiences sees that feedback in real time. Not the promoters, the passives and the detractors. It all comes in. So that Monday, I mean that Tuesday, when you're getting, when you're seeing the Monday's patients, you are, there's expectations on our workflow and by the way, we've set a very high benchmark of 100% of all detractors and passives have to be dealt with within 72 hours.

Wow, that's great.

And we maintain, we maintain a very high close rate. Most markets is 100% and they get notified of those. Clinical leaders get notified of the detractors and passes. And then we have a kind of a scaled approach to if it's detrimental to their health or something specific like that. That's dealt with differently than oh, the room was cold, you know, you need to turn the AC down. And we have a, you know, kind of an escalation level that's different than dealing with, with those, with the expectations of going back 100%. And in addition to that, those leaders will do daily huddles with the teams, obviously, share the good feedback, talk about where we might have some challenges. And we're always coaching. So in this continuous improvement culture, we're always coaching. Right. It's not. We're not saying, oh, Dr. Adam, you're fired because you have a 50 and somebody complained about your bedside manner. It's like, no, this. Because it's a big. This is a big dynamic shift for the clinical professionals in the United States is to have this level of feedback. Most of them, 95% of them love it. They've changed their way of administering medicine. They've changed their way they go about the entire experience. It really, again, disrupted another part of the.

But this seems to me to reinforce the whole focus on the consumer and the voice of the patient really comes to that team pretty much, you know, within 24 or 36 hours, I'm guessing, of when the patient visited. So it's live. It's. Oh, Yeah, I remember Mr. Brown. He was in yesterday. Oh, we could have done better. Or. Or alternatively. And I know from your high schools, which you get onto a minute, I'm pretty certain the good scores really reinforce that team effort. Hey, we did a good job. Another promoter. Right. I'm guessing that must be a big part of it.

Oh, 100%. You have to celebrate the wins. One of the things that we learned from you, from you guys, was we probably focused too much on the negative.

Yeah.

In correcting the negative versus celebrating the positives. And for the last six years, since you guys kind of told us this little nugget of making sure that we are. Because we have so many, so much great feedback that we. We should never let that rest. That that's just as important. We. And we have a whole program for that as well. But if you look at a daily. If you look at a daily record, we're very blessed for this score. We don't do anything to manipulate it. We have zero for the NPS geeks out there. As from a process standpoint, we do zero mention of a survey inside the facility. No one's allowed to say you're going to get a survey when you leave. There's no post it material. The physicians don't say anything. So it's completely scientifically correct, meaning that the patient is getting it without any prerequisite or pre notions. Because we want the honest feedback. And we are very blessed to believe it or not, over 92% of all of our feedback is a promoter. A 9 or a 10 and literally under 5% of all of our feedback is detractors. So.

Okay, I'm just going to put my finger on it here. Right, let's listen it quick fire. What's your typical NPS in one of your facilities?

Our benchmark is 80. We set a very, very high benchmark and a majority of our facilities are over it. We have nobody below 60.

That's incredible. But I'm just going to catch around this because sometimes I see from these big surveys that they do that they have, I mean I've seen them like 99.9% NPS of some of these things that they do on 30 patient feedback. I mean, hold on a second, that can't be right. I'm skeptical of that 99% score. Have you got anything you can talk about on that one? I don't know whether you can reveal real stuff.

Yeah, yeah. The reality of it. And we, you know, we've been the cycle of NPS for a long time and we want to do it right. It's not a public score. Right. So if it was a public score, if we're so wrapped up in making sure that we show an A plus out in the market, what we'd be doing is the physician would be holding the survey in front of the patient saying, hey, you know, I get a bonus if you give me a 10. You know, and by, you know, I remember I wrote your script, you're going to feel better tomorrow. Give me, you know, and we, we know, we unfortunately there's no oversight committee that's saying that's monitoring the feedback. Right. And or monitoring the administration of a survey. So we know now because we've been doing this for so long that when we see the hundreds and ninety, they're, they're physically impossible.

Yeah. Fifteen years in this business also tells me that's an impossible score. It just doesn't make sense.

Yeah, so we know that there's, you know, kind of the gaming of the, of the system. But you know, the way we look at it, that's their prerogative. You don't get anything out of that. You know, you really don't get anything out of that. The fundamental core component of this is, you know, we are a for profit business. We partner with very large health systems and we, we have chosen to save consumers money. That's our business model. Yeah, right. But we still are profit centric. We want to grow. And if, you know, if we're growing, we're disrupting and if we're disrupting we're changing healthcare for the better. If we manipulate that score, we're not doing our job. And here's the one fundamental core component that I can guarantee you that when you are doing nps, right, and you are fixing the challenges and you are improving your daily, you know, your daily output and your daily consumer experience, your revenue will go up. We. There, there. If you have 100 NPS and your revenue is declining and you're closing locations, there's something.

Yeah, I. I couldn't have said it better myself. You're right. We know this because we're in the, you know, we're all in the business of doing nps, Right.

Yeah.

The other stuff is can we. Definitely. A smoke screen.

Yeah.

And. And what I want to try and really pivot to is this concept of good business. And I'm going to hold up Fred's book here. I know that you're a big fan of Fred's record as well, you know, so is Jay Woody. Jay Woody Bendy, who runs your business. I love Fred's book. He talks about earned growth. And I think you also hold the earned patient up, which is the referred patient up, as one of your metrics. So maybe you can tell me a little bit about how that's going. Is that, you know, is that going in the right direction? Is that something you judge your business on?

Well, you know, math doesn't lie, right? The numbers do not lie. And yes, we love winning on purpose. I've read it probably, you know, a million times and listened to it a bunch of times. And we're a big Fred Reinhold, you know, fans, and we're certainly disciples of all of his. Of his teachings. And we're believers because he's right, you know, his math is right that when you see a customer and the customer recommends your business, there is nothing that should be held in higher regards than that. If you think about how personal our recommendation is, right. If I say, adam, go to this restaurant, it's the best thing ever and you don't like it, that's. Now you're judging me. You know, you're judging my recommendations. Are you ever going to take recommendations again from me? So I might be hesitant to be a recommender. So when a 9 or a 10 should be something that should be celebrated so specifically because you have somebody leaving your pay for your services came through the door and now feels now, now holds up the curants in such high regards that they are willing to tell their friends and family to go in. So you ask that question, what's the earned. You know, earned. We call the earned patient.

Yeah.

No, the earned patient is we track very specifically through the survey experience. How was a new patient recommended to our facility? A friend and family member. Right? So we don't call this data. We make it very specifically. I have whiteboards that are all my office just full of numbers and in graphs. And we look at it, we hold that metric is high regard. We open up a facility, right? It's a beautiful building. It's on this perfect corner, right? So everyone going, what is this place? What is this place? So do we see any friend or family referrals in the first couple of days? No. Right. We see, you know, drive by, Internet search all those cool mechanical things that me and my team do to get the patient really aware of what's going on. Then what we want to see is this friend and family growth, okay? Because as patients go in, they leave and they recommend, guess what happens Perfectly. If friend and family referrals are going up and that percentage continues to climb, guess what's going up. Volume and revenue, perfectly cyclical. That is where we are. That is really where we are growing. Guess what's going down? Costs.

Cost of acquisition. Right.

Cost of acquisition. Our new patient acquisition, when we open up a facility is $100. We want. We create this benchmark, and for my team, after 18 months, we want new patient acquisition to be below $25, if not 10. We have markets where our new patient acquisition is $5, $2. It's really, really low cost going down, revenue going up. But if that friend and family number is not going up, we are. We are flat or going down. So here's. There's your annotation. Yes, it's a kind of a complex algorithm, but it's really not. We say every single patient matters if they leave this facility willing to recommend. There's your winning sauce.

Amazing.

Do whatever you need to do to we. And we have. I mean, I could tell. I could talk all day about this, but, you know, we have patient wow scenarios. All the leaders are wow, which is a wow moment. So, you know, hey, bringing a blanket in or, you know, playing with a child, that's, you know, getting a child to smile, that's really distraught and scared. You know, all these little things that we see mention back and patient goes, I love it here. I'm a patient for life. You guys were amazing. Nurse Adam and Dr. David were the best. This is great. Is that patient coming back? 100%. Is that patient recommending 100%? Are we going to get three or four patients out of that experience, you can guarantee it.

I agree. And that's really why I believe you're great disruptors in this field. You're changing the paradigm about people almost looking forward to the healthcare experience that we have. I can't think of a better mission that you guys have to really bring an elevated healthcare experience. It's not just the treatment, it's the whole thing about going in the waiting time. I love what you're doing and if I can just summarize a few points that I took out of this. So.

Sure.

Three quarter of a million patients you're going to get to this year or to the end of the year.

Yeah, it's going to be close. Yeah.

You've got 20% response rate in your survey after serving, you know, 100% of the patients, which is awesome. About an 80 NPS, 100% follow up on all your detractors. This is incredible stuff and I just want to say I love your commitment to this. You guys live the NPS dream. By the way, if I am ever a patient of your group, you know, I would be so excited to do that and patients should be proud. I hope they're listening to this. So I want to just say thanks, David, for talking us through this today. And I love the way that you've given this the whole digital first look at this. But before we go, I know that you are super digital, but you're also an analog guy. Right. You're an outdoors person. So before we go, tell us about the ranch that you've got. I would love to hear about this. It seems this is my goals, I think. So where are you sitting right now and tell us what you've got around you?

Yeah, I am. Thankfully you have not heard the roosters roosting in the background and the animals. You know, it is, it is raining right now, so I believe they're all under cover. But yes, my wife and I and kids, we own a beautiful ranch in North Texas. We're about 15 miles from the Oklahoma border. So far on North Texas, we had a little over 30 acres. But we're surrounded by thousands and thousands of sprawling hillsides actually up here in Villa Franco. So we, we raise authentic Texas longhorns, cattle. So if you see the iconic cow with the long, long horns, we, we raise those and, and all of our, all of those go back hundreds of years. You can trace them back hundreds of years to the, to early herds and, and we have horses and, and chickens and it's really a Wonderful. It's a lot of work at very early mornings and a lot of late nights, but the kids get their hands dirty and. And we eat fresh food from our. We have a farm. We have an eight acre farm. So we eat fresh food from our farm and fresh eggs every day. And some of the cattle end up in the freezer as well. You know, it is. It is quite the experience. We love it in Texas is just. Just a wonderful place to raise a family, do business. It's. It's really got, you know, because we're only 20 minutes away from bustling trade and. And colleges and schools and we have Target and, And you know, we don't have to drive three days to get to or you know, go down dirt roads. It's nothing like that. But it's a. It's a beautiful place. But yes, we're. We are a strict outdoor family. So thank you for.

That's great. Hey, listen, David, thank you so much for sharing a bit about your life as well as your business. I really appreciate it and. And all power to the intuitive him.

Thank you. And we appreciate. And we certainly appreciate Adam can't be left without being said is the. The partnership with the customer gauge and you guys have been remarkable guidance and teachers and mentors for us.

That is too kind. We've also learned so much from you guys as well. Thank you so much, David.

Thank you.

Look forward to seeing you on the rancher sometime soon.

Absolutely. Always welcome. It.