Reimagine Your Practice - A Guide to Unlocking Remote Talent in Healthcare

Welcome to this White Coat Investor webinar. We're talking with the folks from Edge, which is a pretty cool company and I think the first of this type that we've had sponsoring the White Coat investor. We're going to be talking all about some of the services they offer today. We have their co founder and president Rihan with us and their senior director of sales, Ahmed. So thanks guys for being here on the webinar.

Thank you for having us. You know, it's longtime followers, big fans, so it's an honor to be here.

Well, why don't we start. You prepared a presentation. Let's start with that presentation. Then we'll move into a Q and A segment afterward.

Perfect.

Rohan, I'll hand off to you to speak on Edge and the background and then I'll take it from there.

Yeah, great. So this is actually my co founder, CEO ify Wala. And so the pretty interesting story. So we've known each other for about 10 or 11 years. We've traveled probably like half the world together. Latin America, Africa, Asia, Europe, everywhere. And one of the things that we were really impressed with is the talent throughout the world, right? So, you know, everyone's like, oh, you know, Silicon Valley, we're in Northern California. Everyone's like, U.S. europe. You know, the talent here is amazing. But really, I think what really makes us strong is, you know, people from all over the world. And you know, we go to Africa, we go to these places and we're like, wow, these people are really great. Imagine if we can use them in our businesses, right? So if you actually had an insurance company and you know, I think his, his favorite line is, you know, everyone in this room. How many of you guys wanted to be insurance agents when you're in high school, right? No one ever raises their hand. And so you had a hard time really finding people at a reasonable rate. And so what we ended up doing is, you know, we ended up going to the Philippines, we ended up going to India, we end up going to Pakistan, a couple other countries. And we realized the talent in Pakistan probably most closely matched the talent and the skill set in the US and so initially he brought on four people for his insurance company in Sacramento. Within the first six months, he actually ended up increasing his revenue by 10% and he ended up increasing his profit by 25%. And you know, this is shortly before the pandemic. And so at that point, you know, continued, I think he brought out one more person. And about a year and a half later, he actually ended up selling his insurance company for about $4 million more than he would have pre Edge. And he had no other U.S. based employees. It was just those four or five people there. And so at that point we're like, man, this is actually pretty cool. This is, you know, not just giving people opportunity, but it's really giving businesses in the US a great opportunity to find staff at a much lower rate than they would otherwise. And so we started the insurance company, the insurance part of Edge. So we also provide insurance to insurance offices. And then about three or four months later, we branched out into healthcare, so both dental and the medical side. And it's been a great ride ever since. And so I think today, you know, we're up to a little bit over 1200 people. We're based in Pakistan, we're also in Costa Rica and we're in Peru. So a lot of our customers, especially in the southern half of the US where labor is actually cheaper, but it's sometimes it's a little bit harder to find, really do request the Spanish speakers. And so we went to Peru for that. And then we're also in Costa Rica to be in compliance with epic. So we're EPIC certified for that.

Part of the process of going remote typically involves getting past some hesitations, right? I think when you think about hesitations, the number one that Brihan and myself typically hear is security. Will my patient health information be safe across the globe? Will there be any data breaches? In terms of culture fit, will individuals be able to fit into our culture? Today, what we're seeing is as we progress into 2025, Edge, alongside several other organizations, have been able to strengthen the security piece, the culture piece, and we'll talk about that a little bit later today. But more importantly, why are organizations looking into remote work in the first place? Typically you hire through, indeed you hire through LinkedIn and you get connected to local talent potentially through a word of mout mouth type referral. But in today's world, it has become increasingly hard to find good talent. It's even more difficult to actually retain that talent year over year. We're seeing percentages above 30 to 40% of talent being brought in that don't actually last even six months. Costs in terms of labor, of course, have skyrocketed as well, especially if you are on the coastlines. Regardless of where you're at in the United States though, you're seeing an increase in costs, an increase in time to hire, and ultimately that's leading to dysfunction in terms of efficiency within the practice. And so when we look at Edge. As Rohan mentioned, we were first built really in a pandemic time back in 2020, but really as we took our first steps as an organization was really late 2021, early 2022, we identified a big problem which was it's hard to find talent. We identified a solution that there are really, really strong individuals abroad. How do we then become that connector piece in between that talent and employers here are looking to fill roles. The way EDGE works is in a four tiered structure that is hiring certification through something we call our Edge Edu enablement, actually having someone go live at a practice and then last but not least, the scalability piece, hiring front. As Rehan mentioned, we are really live in two geographic areas, two regions in the world, which is Central America as well as Southeast Asia. In Central America we have found and being able to provide very, very skilled, bilingual talent individuals who come with background directly in medical translation, medical practices and potentially even insurance and verification around those areas. On the Southeast Asian side, specifically in Pakistan, we have seen a lot of experience with medical background, individuals who have gone to dental school, who have gone to medical school, who unfortunately are dealing with south, who are unfortunately dealing with a lot of south saturation and who are looking for career long fits. And so once someone is identified as the right fit for Edge, we now put them through our five week course. This is a self serve five week program where individuals will not only get HIPAA certified, but go through the aspects of medical terminology of the day to day tasks that they would be doing ultimately so they are prepared to join your team as a true team member. Now once someone actually passes that certification, now they're able to meet you in that interview process. So Dr. Dali will use you for example in the scenario where you are looking to hire an individual and say, here's the jd, here's the soft skills that typically we've seen success with. We will take this to our Marketplace team and say, can you find Dr. And his staff, three ideal candidates? From those three candidates, you would interview them one by one. Ultimately, once you decide to select an individual, they now become your full time employee. So this is not an outsourced random person in the world. This is truly someone that is simply remote, but that is still a true member of your staff with the day to day management being your responsibility at that piece. Once you have seen the value of Edge and ultimately are ready to bring on your second, third or fourth individual, we have developed a platform that enables you to not only manage that individual or team of individuals effectively, but, but now you're able to scale very, very easily as well. This is just a dummy screenshot of what a platform login would look like for any of our clients. You'll get access to your entire team, their salary, any type of holidays or time off that they have requested to you. And the second piece of this that we're working on for later 2025 is the scalability piece. So once you have identified what makes someone the right fit for your practice, you now will get access to talent that's in our marketplace. So when you're looking to bring on your second, third or fourth employee, we'll show you who is a matching type of profile within our marketplace and you're able to hire them even quicker. And so in a nutshell, that is how Edge works. Now. One piece I did mention was the five week training program which we consider our Edge Edu. Effectively, this enables employees to come in, get certified and and be recognized for positions which are the right type of fit. We have this broken down into four different certifications. One more being focused towards patient facing roles, several being picked towards backend roles such as insurance verification specialists or a billing coordinator. And fourth but not least, we have seen a huge rise in popularity when it comes to requiring scribes. Right? Physicians are not only tied down in the amount of appointments they're seeing, but now they're having to also update all charts and the emr. And so having a live scribe with you enables you to save a ton of time and be regulated within that piece. Some of these support tasks that we're able to help with, as I mentioned, are broken down into several different types of positions. So when you think about someone who is more patient facing or front desk facing, tasks such as call management, scheduling, patient registration and referral management, I would say are some of the most popular we see on the back end when you're thinking about roles to help. Insurance verification and prior authorizations are a big, big time spent typically from an administrative perspective that we're seeing with practices. So being able to push those tasks off and have your in person staff focus more on patient facing rules typically is very, very successful and saves a lot of time. We wanted to show you a live example of someone who is in our marketplace today, someone who actually represents one of our clients. So we're going to share a quick 30 second.

My name is Iman Makar and I'm associate client relation here at edge. My relationship with my client is super chill. I've been working with the GI Associates for the past three months. And I work with Dr. McDougall, I work for him and he's really supportive. He is just super understood understanding of any situation and he is just always there whenever I need any help or any guidance or supervision, yeah, I just give him a call and then he guides me through it all.

In regards to this video, you were able to see just an example of the talent we have. One thing that Dr. Rahan as well as ify our co founders did back in late 22 was really pay in the 97th percentile per the countries we serve. So in Pakistan and Peru we've identified that by paying individuals what they're worth now you get strategically talent access to the top 1, 2, 3% of graduating talent every single year. Because of this we're able to also really quantify what makes someone a good candidate. And so when it comes to English speaking skills to match western speaking skills, we have found a lot of success in that regard as well.

Yeah, actually we used to say we're more selective than Harvard. Right. But I think some audible one of these companies actually took our line. But one of the things is, sorry, acceptance rates is actually between like 2 to 3% as Ahmed said. So that means, you know, everyone's, I think like 99.9% of the people are college educated. But more importantly everyone's English is, is very fluent as you know, you saw from Iman's English on the previous thing. And so those are really the, the, the two most important things and really the English, the customer speaking skills and the education. So I think almost every one of our customers, when they actually meet the three people they're interviewing probably half the time, if not more, they're like, man, I wish I could just hire all three of them or two out of the three because they're so impressed and they're like, man, I wish I could have front office staff or mas who actually went to college, graduated college. And then I think we have probably about 20% of our people are medical doctors. About another 15% are dentists and another 15 to 20% are pharmacists. Right. So almost about half the the field has some sort of medical background, long training, you know, so it's actually really changing my life. I'm making three to four times as much as I do in residency or in training. But I really need to do this to either pay off the loans or get a better financial situation. So that, that is actually a really important part of why we started this company. So you know, it's great. It's a business and all that, but the social aspect is really important. And I think one thing that we, one number we really like to cite is at one point we never hit 70%, but we were a 69.3% female at one point. And now I think we're like around 66, 67%. And so I think a lot of people are aware in a lot of countries, even in the US it's a lot easier to get hired as a male in a lot of industries. And in Pakistan and Latin America sometimes it's, you know, near impossible to find a high, really high paying job as a female. And we're really proud of that. Obviously it doesn't really impact your office in a lot of respects, but it does impact a lot of different people's lives. So we're really, really proud of that.

Yeah. Thank you, Rohan. And so, you know, we date back to what we said early on, which is what is the number one hesitation that practices typically face when considering remote employment? And the number one piece is security. And so some key takeaways for our viewers today. Number. You know, we are a United States based organization in Northern California and we do also have headquarters in Islamabad, Pakistan and Lima, Peru, both capital cities in those respective regions. From a HIPAA compliance standpoint, our organization is HIPAA compliant. We do mandate each of our associates to also go through HIPAA compliant training. All equipment is provided by Edge. So computer monitor, headset, typically access to your voiceover, IP and Internet are all provided by Edge. We do not allow associates to access any type of patient health information, any of your software through their own devices. One thing we've also done to ensure all information is encrypted is mandate a HIPAA compliant VPN. Today we do use perimeter 81. And then really last but not least on that piece, we also do sign a BAA as an organization. There are companies out there that do sign baas with international employees, which truly doesn't make the most sense. But we actually sign it with edge, the United States based organization. So you are covered as a medical.

Practitioner maybe actually if I can step into that. So BAA Business Associate Agreement, right? So I think when a lot of people go through this process, they're like, man, what's a BAA or Business Associate Agreement? And we're like, okay, so you know there's hipaa, right? So anytime you contract with a different company and you have to have an agreement, right? Otherwise I mean anyone can say the HIPAA agreement, HIPAA compliant. But most insurances and best practices do require the business associate agreement. So there's other competitors or companies maybe in the same field or space, they're like, okay, we're going to have the person and you know, say like India or the Philippines sign it. Right. But if something goes wrong, who, you know, who's taking responsibility? Is it really that person in India, Philippines who has maybe a few hundred dollars, a few thousand dollars in their savings? Right. Are you going to hire a lawyer in those places? And so there's really no responsibility, I think by a lot of companies in terms of the business associated agreement. So you can't really have HIPAA unless you have a baa. And that's one of the things I think we were definitely the first company to do it and we're still one of the only few that do it and we don't charge extra like most other competitors for this.

Yeah. Thank you, Rehan. And to wrap up security, we also are SOC 2 certified. So we hold that highest level of cybersecurity clearance here in the US and abroad. Now in regards to timeline, this is the, I would say the second most popular question, right? How quickly can I hire someone if I've identified them as the right fit? And we want to ensure that not only are we by providing a training program, a certification program, or enabling individuals to get ramped up a lot quicker and provide value to your practice quicker, but we want to ensure that they will actually be ready to go within a quick amount of time. And so today, once someone is identified as the right fit, our typical timeline roughly is about two weeks. Within that two weeks, we're doing a couple of different things. So we're doing an onboarding meeting. Each of our clients is given a dedicated customer success manager who will really guide them through success and ensure that support is there for both the associate as well as them as the client. Once we do that, we collect any type of credentials required. We collect client specific training to also train the associate. So that way, come that first day, two weeks from the interview date, they are, they're ready to go and provide a ton of value. So a pretty quick turnaround rate that we see across the industry and a quick case study that we'd like to share with you. You know, one of our, one of our Most popular clients, DHR, which is a health group based in McAllen, Texas, was really struggling with several areas of hiring. And so one, they were struggling with hiring in general, not being able to get connected to individuals to come into medical assistant type positions, but also knowing that they are a town that is on the border of Mexico. They were not able to find bilingual individuals when 60% of their patient population, if not more, actually speak Spanish as the main language. And so by partnering with Edge in early 2023, they started with three individuals to help that medical assistant team. And when we fast forward to Today, less than three years later, they have grown to 75 remote employees across different sectors within their organization. Just to give a brief overview of the type of savings when we're looking at costs that the group is saving. On average, they were paying about $60,000 per employee, including benefits. With Edge, that number was brought down more than 50% to $28,000 a year. And so when we look at their total savings over their their entire tenure with Edge, which is less than three years, over $3.6 million saved for the organization. And that's simply from a cost perspective. Rehan, you can probably speak on the actual efficiency perspective where they've saved a ton of money.

Yeah, so DHR is actually the largest physician owned hospital in the country, as I mentioned, right on the border of Mexico. And so, you know, ironically, they're like, man, you know, minimum wage in Texas is like 7:50 an hour or $7 an hour. It's the national minimum wage. And they're like, even if we pay twice that or three times that, we just can't find people. And so, you know, we actually worked with one of their clinics. So they have the hospital plus the clinic group. And you know, we started with three and then we slowly grew. So right now we actually do. And I think like in their oncology and one other in cardiology departments, we actually do about 98% of their prior authorizations. We actually have, there's like a few pharmacists and there's a few doctors who actually work on there. So imagine doing a prior authorization and you have a doctor doing it right. You know, your success rate is going to be obviously way, way higher. We also do some of their billing, so we do a lot of the rejections and you know, follow up claims that were not initially accepted. You know, we also run one of their kind of almost like a call center during the day to help efficiency. So I think they went from having an average wait time of about 50 to 55 minutes down to about 5 minutes. So a lot of benefits for that. Right. One is A, the patients are happier, but B, they're also able to schedule the patients, reschedule the patients. I know you're an ER physician, so it doesn't really impact you as much. But you know, if you have a clinic or like an IOP php, some sort of hospitalization program and someone wants to get into the clinic, you know, that's great. You know, they call, you know, pick up, they're going to hang up, they're going to go to the next person. Right? Same thing with dentists, same thing with insurance companies. So we're able to get that in. But also if they're not able to make the appointment, if they can't get ahold of someone, they're not going to, they're just not going to show up. Right. I think that's probably the most common thing. They're not going to wait an hour and be like, oh, I can't come tomorrow, the next day. You know, so we really make it a lot easier to do that. So their patient satisfaction scores went up, their no show rates went way down. And you know, we're able to refill medications, you know, if we have pharmacists or doctors either call it in or we penned it in Cerner or you know, epic, depending on the company they use Cerner. So basically across the board they've, they've been, you know, really great partners with us and they've really helped us out. So I think with them, the, you know, on here, the annual spend, it's a, the savings actually tends to be a little bit more than this. So most of their employees are in Costa Rica or they're in Peru, which is more expensive countries in Pakistan. And so the average customer does actually save more than this. This is just due to their unique requirements, both being in Latin America plus also the type of employees they wanted.

And this is a case study to of course a larger group, as Rehan mentioned, the largest physician owned group here in the United States. We have seen our bre and butter as an organization really be in that one to 20 provider space. And so whether you're a one provider practice, solo provider practice or a large group like dhr, we have built the tools to ensure that we're able to meet you in your requirements of finding the right type of employee. And with that the challenge becomes will 2025 be the year that you transform your practice with a remote employee? Dr. Daly, we appreciate the opportunity to not only speak with you today, to be partnered with White coast investors and ultimately have an opportunity to speak with your group. And I believe at this time we will push to you for the question portion of this.

Yeah, well, great job on the presentation. I mean this is pretty cool. I mean the White coat investor is a remote company, right? Nobody goes into the office when they go to work during the day. Everybody works at home. And we have people all over the country and outside the country. We've had tech help in Eastern Europe. We currently have a full time tech guy in Brazil. So this is not an unusual concept at all to me to hire remotely and have people work remotely. This is not unusual at all. Where I haven't seen it though, is in medical practices. And I think this is where your ideas and your company is really revolutionary. That doctors and nurses and practice administrators haven't sat down and said, well, who do we really need to be here? And what jobs can be done better remotely and certainly less expensively remotely, which I think is a huge sales point you have here. Right? I mean, if you're paying half as much for your labor, all of a sudden now the doctor can see fewer patients per hour and still run a profitable practice and have happier patients. And you know, when they call, there's somebody to pick up the call and those sorts of things. So it's pretty exciting to be able to offer not only better service, but less expensive medical practices. This is a big issue for doctors across the country. They're flocking to employment because they cannot make their medical practice financially sustainable. And so this may be a big part of that solution. So congratulations to you on what you've created and let's see if we can get you connected to those practices that can most benefit from the partnership. Now, let's talk about some of the questions here that I think people have. Let's talk a little bit to start with about an effective hiring process for remote talent. I think this is where people sit back and go, what do I need? What can I have that's not here sitting at the desk, at the front desk? So what does that effective hiring process look like from beginning to end?

Yeah, yeah, absolutely. I think, number one, it's similar to hiring in your local market. It's really identifying what makes someone the right fit. Right? So truly having a job description built out, understanding the soft skill portion of what makes someone the right fit, that's component number one. Component number two is, are you partnering with the right organization that ultimately will not only connect you to quality talent, but also be that ally in terms of their structure, their support, and their success at the organization. Once you've done that, the biggest hesitation typically we see is, hey, we're trying this for the first time. We've never trained an individual through zoom, right? Or Microsoft Teams. We can't see them. So we don't know what their attendance will be like. And what a lot of these physicians have found is that it's actually not too much different, typically in terms of partnering with Edge, building a training program, whether it's access to an emr. Right. Let's say your practice is using athenahealth. There's a lot of tutorials already out there that exist where individuals can quickly get acclimated and up to speed. Yes, you can't get the credentials until day one, but you can get a good understanding through training of a general EMR system in terms of the responsibilities, as long as the associate or the remote employee has access to one individual that they can shadow. Right. For a week or so. Typically we find that process to be pretty straight line, pretty straightforward. So ultimately, I think if you're able to identify the right type of fit, what makes someone a long fit, long tenure at the, at the practice, really, there should be no other complications along the way.

Yeah, I think maybe one thing I can add to that is one thing that's really made us successful is, you know, as I mentioned, the, the training team. Right. And so there's something called the paradox of choice. Or you can go on like tons of platforms. There's like a lot of people out there. If someone presents you 100 people, you're probably gonna be like, man, I don't know what to pick. Right. If there's like 100 ketchup varieties, like, you're. No matter what you pick, you're gonna be like, man, I think I picked the wrong one. Right. So what we do is we, you know, learn your practice, you know what you need, and then we come and we present you with three people who are tailored to your practice. I mean, I'm a doctor, you're a doctor, Right. You don't want to spend 15 hours just trying to narrow down the people. And so I think what most people really appreciate is here's person one, person two, person three. They're all really good fits. Which one works with my personality in my practice? And I think that's really helped us a lot too, in terms of the hiring process. Yeah.

Have any of your of the folks working with you ever, like, wanted to fly somebody in and have them meet the team in person or they pretty much, they're hired remote, they stay remote, they work remote for years, and that's the way it is?

No, no, definitely both, actually. So we've had, I think six or seven people fly to Pakistan and meet their people. Our second Largest client. It's actually insured tech company. They went to Peru. They go to Peru every time. They hire, like, four or five people. They'll meet, like all five, train them in person for a week, and then go back. And then we've actually got a pretty good relationship with the government of Pakistan and then the visa process coming to the US and so I think we've had about 12 people fly to the US either for training or just to meet and greet the. The team. And that's just from Pakistan. And then we've had a few people from Peru do likewise. So it's. People are like, man, you know, I've been working with this person for a year. They're part of my family. I mean, you know, your mas, your nurses. Right. They're part of your family when you're. When you have a clinic. And it's no different with remote employees.

So, yeah, this is a little bit how we feel about one of our tech guys. Rafael works for wci, and we flew him into a WCI con in Florida and all got to meet him. And that was pretty cool to be able to kind of close the loop there and just feel like a little bit more of a team. So that's fun. That that's at least an option for people to consider.

Oh, definitely an option. Yeah. And then we've been to conferences where we had one of our people from Pakistan, and we're like, which person's person from Pakistan? Which one's the person from the US and I think about like, 70% of the people figured it out, but there's still like 30% who are like, man, I have no idea. I think that's kind of the quality of the people we can bring. And it seems like Rafael's the same way.

Yeah. I think the worry people have is, I mean, companies have been outsourcing help, particularly telephone help, for many years. You know, the classic example is India. You know, and everyone complains that I got connected to a call center in India and I couldn't understand what the person was saying. Their accent was so bad or. Or something like that. It sounds like you've solved that problem.

Yeah, I think that's one of the things we're most proud of is that, you know, you can go to a lot of countries, right? You can hire someone for like, 3, 4, 5, $600 a month, but, you know, are they going to stay with you? Is the quality very high? Because, you know, these people in Pakistan, they are working nights, right. So you do have to pay more and then obviously you have to pay more to attract more, a better quality. And so I think the combination of that and then also having really good Edge headquarters in Lima, in Pakistan, where people do want to come in and work and they want to spend time and you know, we've created that culture on top of that where people are proud to actually work for Edge. I think it's a combination of all those. I mean, I'm a psychiatrist, I know how hard it is to work at night. You know, you got to sleep, you have consistent schedules. And so, you know, if you want to recruit the highest caliber people and then also keep them, you have to do a lot of this other stuff to do it. You can't just be like, I want to hire someone in, you know, Pakistan or India, let them work nights. They're not going to meet anyone, they're not going to know anyone, they're just going to answer the phone call. I guarantee you they're going to be gone in six months no matter what you pay them. So.

Right, so, so is the help working in your office in Islamabad or are they in their homes or where exactly are they working from?

Depends. Right. So most people work from the office. Probably about 50 work from the office and then, but you know, we have Islamabad, we have Lahore, we have Karachi, we have Lima, we have San Jose, Costa Rica. And so, you know, 69 women, 66, 67 now. So not everyone is able to go into the office. We do provide transportation. So we have someone pick them up and then drop them off. Usually it's like a car with like two or three people. So as many people as can go in there. So if you're like, hey, you know, I want someone to work from the office, you know, we can make that happen. But generally it's about half the people work from the office, the other half work from home. And I don't think we've had any complaints. Not like there's like dogs barking in the background or all this other stuff. I've had that happen with T mobile, I think had like T mobile, like the home wife Internet one time, right. And there's like chickens in the background during the pandemic. So none of that stuff. It's, it's even if they're at home, you know, we, we verify that A, they have a primary Internet that's a certain speed and they also have a backup Internet. So we give them like one of those MIFI devices just obviously to make sure. And then we also make sure the background, the lighting, we give Them a laptop, we give them a second monitor. So we make sure that everything is the highest quality as possible.

Yeah, I think people just are having trouble making the jump to remote employment right now. They've got an machine that does certain number of things in clinic and what things can be done remotely that people haven't considered having done remotely before?

Yeah, you know, Dr. Oli, I will say, I would say, you know, over 50% of our partners today that have more than one individual on their team through edge expressed a concern of making that exact jump. Right. And they had a need for three, four, five individuals, but ultimately wanted to start with one because of that hesitation and quickly found out that, you know, within 30 days of that first individual being live, hey, this actually works. Let's bring on number two, three, four, because we know now that, that the structure is there in terms of job responsibilities. I think the number one pain point that we hear practice owners or office managers tell us is the amount of phone calls that are coming in. Right. And how they are, how they're being overburdened with not only checking patients in and taking that intake, but also trying to pick up the phone and do everything else in between. So I would say number one is phone management and scheduling. The other big piece, Right. That we typically see a ton of value in is the insurance verification or prior authorization piece. That one call can take 30 minutes, if not an hour. And so when you're able to push that task off and have someone dedicated directly to that craft and it not only saves a ton of time, but now your patient experience, typically those scores, those NPS scores typically increase as well.

Yeah, well, it's pretty exciting. I think people get excited when they hear about this. They're like, well, I can cut my labor cost in half and have more talented help. You know, now I've got a physician basically working as my ma. That's pretty exciting. I can see why people get excited about, about what you're offering here. I think we've talked about a number of things today. Let's talk a little bit about what motivates healthcare organizations, whether it's a clinic or a multi clinic organization, to make this leap to go. We're going to do remote talent. What's the motivation? And if there's decision makers that are resistant to change, how do you overcome that?

Yeah, I think that's a very good question. I think, you know, I think most healthcare organizations, if they're like, you know.

They can find everyone, typically increase as well.

Yeah, well, it's pretty Exciting. I think people get excited when they hear about this. They're like, well, I can cut my labor cost in half and have more talented help in their area who can.

Come in like, man, that's great. That's the ideal solution at a fair salary. Right. I think, I think we can all probably agree on that. Right. But you know, when you, when you have a lack of workers, right. Usually it's not like the first week or the first month where they're like, man, I can't hire someone. Right. It's like three months, six months, maybe like multiple years in and they've had people who leave for 50 cents more an hour, right. Because it's like a 10 minute, 15, 20 minute commute. I think we all had staff.

Like, there's nothing more painful than losing a nurse to another hospital for 50 cents an hour, you know?

Yeah. No, it's incredible. I mean, it happens, right? It's like people are like, no, you know, they're kind of surprised, but you know, a thousand, $2,000 a year, they, that happens like frequently. And so I think once they go through that and then they'll look at us, maybe they'll talk to us. Some people like, you know, dhr, they jumped right away, right. I think it was like a week process before they talked to us to starting other companies. They work through it, they have concerns, they have questions and we try to answer those as much as possible. And Ahmed, you know, does a really great job of answering a lot of those. And so you could probably make touch base on that more.

Yeah, you know, it's a, there will always be a decision maker in a group that is against this. Right. I think that's, that's fair to say. And I think there's, there's. They're right in their mind to have those hesitations. You know, we spoke about kind of that T mobile experience, right. The number one thing we hear is we don't want our patients to have the Comcast experience, right. Where you are outsourced only to be connected to someone in this local region that can help you in just a couple of minutes. And I think, you know, credit to Ify and Rohan here, where, you know, not only identified, hey, we want to ensure we're helping, you know, employees on the other side, right. And get that, get access to fair wages and live a different type of life. But also for us now strategically, because we are paying in that top third percentile, you are able to be very, very selective with the talent that actually comes in to have the Opportunity to partner with these organizations. Right. And so we always speak to our quality. I think the number one piece that we'll do is similar to today, right. Share over a respective example of someone that's currently in our marketplace, someone who's ready to interview. When you have a chance to look at these resumes and you see the type of background they have, usually those hesitations are quelled pretty quickly. And then of course you factor in the increasing wages. Right. Rohan and myself, we are in California and here in California in November last year, they mandated a $25 minimum wage for medical professionals. Right. Specifically medical assistants and really anyone in that space. And so when you're thinking of a solo provider who is looking for talent that can't afford paying 25 an hour plus benefits, edge almost becomes a no brainer at that position considering the type of quality that you're accessible to.

Yeah. And actually one thing I'm going to mention is A$25 an hour minimum wage for most healthcare organizations, right. Things like above 25 or 40 employees, you know, so if you're offering 25 an hour, you're competing, I mean, you're competing against them, right? So if you're offering 25, Kaiser or Scripps or UC San Diego, UCSF, they're offering 30, 35, plus a pension, plus benefits, plus all these other things. Right. And so if you're just offering 25, they're probably, you know, like we have one of the largest neurology groups in San Diego as a partner and they're like, we offer 25, $26 an hour, they last a year with us, they get trained and then they go to UC San Diego, they go to Scripps, they go to these other places and we just can't keep them no matter what unless we're paying like 40 bucks an hour, which is, you know, benefits all in is probably about 100 to $120,000 a year package. Right. So office space, laptops, tech support, HR support. Minimum 100,000. Right. So.

Yeah, I'm not sure the politicians that come up with these increases in minimum wage think about all the, you know, downstream consequences. Often we've seen this in, you know, fast food restaurants. You own a McDonald's now and you don't talk to somebody for your order, you put it in on a screen. And you know, the only employees there are the ones that have to be there putting the food together. And it's not unusual to see businesses develop. Entire businesses come up and come into being to help solve the problems Caused by the fact that, you know, a physician practice can't be, you know, profitable, can't stay in business when every employee costs $120,000 a year. You just can't do it. And so it's pretty cool to learn about one of the solutions to that issue. Okay, so the organization has decided we're going to do it. We're going to hire some remote people. What's the best practices to ensure that this goes smoothly? Because this is a transition to go from this person that's been in the office with you to now having remote team members. What's the best practice to make that go smoothly?

Yeah, absolutely. So I think number one is the mindset, right. Dr. It's really identifying an individual as truly a team addition, a culture addition to your practice, not just an outsourced member. And I think once you're able to do that, introduce them to the team and really give them that responsibility to grow and build out a path of growth that you will find the success rates skyrocket. And we've had plenty of customers who have told us that an individual has worked their way into more responsibilities or leadership. Right. Because of the dynamic background they bring. Ultimately it's that I think also it's, it's getting everyone in the, in the clinic on the same page. Right. Whether you are, you know, replacing a role that's lost, whether you are trying to become more efficient with costs. Individuals within the practice. Right. Who may have similar roles can feel a bit of pressure from that. And so I think introducing everyone prior to start date and understanding, you know, what, what, what we're trying to accomplish by doing this, is it incredibly important Having a JD that's well detailed would be the three areas, I would say that make the most sense pre start. I think once you do start, then communication and expectations, laying that out like you would with a in person hire go a long way and then from there you bear the fruits of what you've done.

Yeah, I agree. I think one thing I'd like to emphasize is really the expectations that you have. So if you're like, man, I want this person to come in and do these seven tasks, it's just not going to work. Right. You have to train them, I think just like any other in person employee. So we've, you know, I don't know if you remember to residency or if you work in a new hospital. I mean, you know, you kind of get everything right. You know, like nowadays if you switch hospitals, you know, probably like 95, 98% of stuff. But they're still like, you know, ehr, small things. Whereas this, whereas that, you still have to learn, right? You still have to be trained. And so imagine someone in, you know, not in your city, not even your country, different healthcare system, but you know, they've been trained, right? So maybe 80, 85% trained. And so if you go in there and be like, I want you to do all these things. Yeah. I think you have to take a step back and be like, you know, when I hire someone in the US does my staff know how to do all these seven or eight things? The answer is, okay, you know, if they've been there like two years, three years, they probably do. But when they started in person, did you give them one task and two tasks or did you give them seven tasks all at once? Right. And so we've had people, they're like, here's a long list, here's a list of seven things. I need them to do all that on day one or day two, and it's just not going to work out. Right? But if you give them three, like one or two tasks, the first a couple weeks, let them master that and then, you know, week three you add one, week five, you add one. That's how it works and that's how it's going to really work for your practice, I think.

Have you witnessed any friction or tension between the employees that are remote and the ones who are not remote? You know, maybe the ones that are remote or realizing the ones that are not are being paid more and more. You know, the ones that are, that are in person may realize, well, shoot, the remote employees actually have way more education and expertise than I have. What kind of frictions have you seen there in the workforce when you have a mixed group of employees like that?

You know, I think when we first started so about four or five years ago, we probably had a little bit more. I think, you know, the in person people are like, man, this person's, you know, English is really good. They're educated, they're smart, they're making less than I do or whatever. And so I think, you know, sometimes there can be a little bit of fearfulness of that. I think, you know, it's very natural. We see that in every company, right. Even when someone starts new in person. And so one of the things that we, you know, I think as am had mentioned, right, Is really making sure that the people know that they're not there to take your job, but they're really there there to supplement your practice and to make It a better and easier patient experience. So yeah, I think both ways there, there, there is some of that. I think people, you know, if you're in Pakistan, Costa Rica, Peru, sometimes there's some deference probably maybe a little bit too much sometimes, especially to the doctor or the other people. And yeah, I think deference is important, but it's also important that you take initiative, that you do what you need to do. And so during our training and even afterwards, we do really work with the staff to make sure. And then the other thing is we do have a post start date team, so we have a customer success team and then we have a talent success team. So both of those teams do work with our talent in Latin America or South Asia. And we want to make sure that it's a continuously like as smooth as possible. Right. Nothing's ever perfect, nothing's 100% but as smooth as possible experience going forward, if there's any issues, we want to be the first ones to know and we want to let you know that there's issues. That doesn't always happen and you let us know and we work with the talent, we work with you to try to make sure that any issues are ironed out.

It sounds like those teams would help quite a bit in fostering effective communication between the remote employees and the in office team. Any other strategies you can think of that improve that communication?

I think Rehan mentioned them all. We haven't necessarily seen, at least in the last several years, friction in that regard, especially. Dr. You mentioned the salary difference, but I think there's also an understanding that that exists. Right. It's not necessarily a shock to anyone. And of course wages, cost of living is significantly more in the United States. Right. And so I think ultimately it evens out the thrill they have at the opportunity to join a practice and be there long term. Typically oversteps any of the other feelings. Right. And I think if the employer is building out a path of success, whether it's something as simple as a Christmas bonus or salary increases year over year, nothing too dramatic, but just something that signifies success and growth, it's a pretty easy process to overstep those concerns.

What's the feedback look like both from staff and from patients after integrating remote talent into the team?

Yeah. I'll tell you from a quick story that I can share is we like to reach out to our clients. Right. Of course, to check in, see how things are going, whether it's a year, whether it's several years. And I've ran into this scenario five or six times where I've called. And I could not tell, to Rohan's point earlier, if I was speaking to an edge remote employee or to truly someone that's in house over there at their location, how that signifies the patient experience is pretty similar. Naturally, if you bring on someone from Pakistan or Peru, they will have a level of accent. Not everyone, but a small level of accent. But the English is extremely westernized and clear. And so knowing that the United States has become a melting pot, it's no difference in that regard. Right. This person could have been hired from one town down versus a couple countries over. So our experience from a patient perspective has been really strong. And then I think from a employee employer perspective, as long as that job description is defined, and I would say that respect is there on both sides, typically the feedback is usually positive.

Yeah.

Awesome. Now how do you quantify, I mean, you're going this route because you want to improve things. You want a positive impact on getting more talent or lowering operational costs or becoming more efficient or improving scheduling and patient follow up and those sorts of patient centered things. How do you quantify all that?

Yeah, I mean, I could touch on a couple of those. I think some of, some of that's really hard. Right. Some of it's subjective. A lot of it you can test. Right. So I know we have an OB practice in Mountain View, like very close to Paul, to a very expensive cost of living area. Right. And the owner, she's actually been one of our loudest evangelists since the very beginning. And she's like, you know, my doctors, they go home at 507 every day because I gave each and every one of them a scribe, including a Brazilian speaking, a Portuguese speaking scribe. There's evidently a lot of Portuguese speakers, Brazilians in Palo Alto. Right. You know, like tech center. Right. So that's one. Right. So all their doctors are leaving by five, 10, their notes are done because the scribes were able to do that. The other one could be, you know, how long does, how long is the wait for a patient? Right. So if they're calling, do they have to wait 5 minutes, 3 minutes, 0 minutes or an hour, 2 hours? 3 hours. Right. So that, that goes down also prior authorization, success rate for some of that stuff. Right. If, you know, so outpatient, doctor, cardiologist, whatever, they need an echo or they need a ct, mri, you know the time to get those. In a lot of our practices, they've gone down from about 10 to 14 days to about three to five days just because they're being done sooner, they're being sent in. And then a lot of our people, they can do the appeals themselves, especially if they're like a doctor, pharmacist, or a dentist. So that's one way, I think it's really tailored to your practice. A lot of people use Cerner, Epic, Athena, whatever it is. They also use voiceover ip, and so a lot of those statistics are available there. One of our customers, they told us the way that they know this is working is their life is just easier. A lot less heartaches, a lot less headaches, and they're able to go home at 5pm, 5:30 on a Friday night, and they don't have to worry about a lot of stuff until Monday. Whereas, you know, they know their staff's gonna be there, they know this stuff's gonna get done. And we have people who work over the weekend, and they're like, man, we have these prior authorizations or we have these notes or whatever, and they'll, like, follow up and do those over the weekend so that they're done or the chart prep's done for the Monday morning patients. Yeah.

I mean, when I talk to practice owners, when I talk to hospital administrators, one of their biggest issues is staffing shortages. They just can't get the people they need. They're willing to pay. They're trying to hire, and they can't get them how much, you know, how does remote talent contribute to solving that issue? Is this, like, the main reason people are coming to you, you think? Or do you think people are coming primarily to cut their labor costs?

Yeah, I would say it's both. So I think you have a lot of practices that are definitely reactive. Right. That are trying to solve the issue that they currently have. And then you have the proactive groups that are planning ahead. And Rehan and myself, we were at an organizational trade show recently at mgma, and we were speaking to physicians across the board, and everyone had the exact same experience. Right. We've been hiring for this position for three to six months. We've had people come in and then just go ghost in the interview process. So a ton of unprofessionalism. You have individuals who are just not qualified, or if they are qualified, you know, they're looking for a certain amount, we're not comfortable paying. So I would say that's the number one thing we hear, unfortunately. Right. And that issue will only get worse. That is directly what we solve. Right. So, you know, we're on average taking that hiring time from about three and a half Months to about two weeks. Right. So it's a, it's a very heavy decrease in time. And then retention rates for us, on average we're seeing in the medical space, especially in the medical assistant or front office space, that average tenure today in the United States is ranging around six months, whereas our year over year retention is above 90%. So ideally we solve that main issue of not being able to find someone in a quick scope, but then also not having to go back over and over and train individuals on the same thing.

Okay, all right. Now let's say we've got somebody that's been sitting through this entire webinar and they're excited. They're like, well, this sounds like this can really fix my practice. I'm not going to have to, you know, sell to private equity and become an employee after all. How do they get ahold of you? What's the best way? I mean, other than going, you know. Our link that we'll put out there is whitecoatinvestor.com edge. But where else can they go to learn more about you?

Yeah, yeah, absolutely. So I think that link would be prominent going on our website, which is www.onedge.co or emailing salesdge co would work as well. Ideally they use your link so we know they're coming directly through you. Dr. And we're able to continue this conversation that we've had today.

Very cool. Anything we haven't talked about today that you feel like people ought to know before we sign off.

Now? I think we've talked about like almost everything, but I think, you know, really want to emphasize, you know, it's really the quality of the people. And I know you mentioned like cost savings and we mentioned it's a big thing. But really, you know, people come to us because they want a high quality employee. They want it relatively easy. I mean, hiring is not easy. Right? I mean, I hired people, you've hired people. And it's, it's, it's a crapshoot. Right. A lot of times even if someone's like super qualified, it might still only be like 80%, 90%. Right. You're still going to lose a lot. And so we're really here to make it a lot easier to run a practice, a physician owned group or you know, mid sized, large hospital, whatever it is. But we want to make it easier for you to do your job so you don't have to worry about all these other things.

So yeah, first you get people, which is a big need, all over the place and then you get good people and you save money. I mean, this is a win, win, win all the way across. So thank you so much for not only coming on and doing the webinar, but for starting the company in the first place. You know, this solves a very real problem for a lot of docs out there.

Yeah, no, great. Thank you. Thank you for having us. It was a great experience. And, you know, as a long term, long time WCI reader, both Facebook and the forums and everything, you know, it's a pleasure to be here. The hosts of the White Coat Investor.

Are not licensed accountants, attorneys, or financial advisors. This podcast is for your entertainment and information only.

It should not be considered professional or personalized financial advice.

You should consult the appropriate professional for.

Specific advice relating to your situation.