It’s an exciting time for tech startups operating in the healthcare space.
VC investing in digital health has gone up each year since 2011 and the midyear funding numbers suggest that 2016 will continue this trend. As value-based care replaces the fee-for-service (FFS) model under the Affordable Care Act, healthcare stakeholders are looking for innovative solutions to adjust to this new business model (e.g. cut costs, reduce waste, boost health system efficiency, encourage patients to manage their own care, etc).
Many of these startups, however, face the challenge of selling their tech-based solutions into organizations with:
- limited budgets
- highly regulated operations
- teams of stakeholders with different goals (not just one decision-maker)
- interoperability (the capacity to integrate new technology into existing systems)
- requirements that solutions be “evidence-based” and backed by clinical trials
I spoke with several premier health-tech startups including Zipongo, Welkin Health, Smart Patients, PlushCare, and ConsejoSano to gather their insights and best practices for selling digital health products. Here they are:
1) Know your Decision maker(s) and Champion(s).
If you are selling a B2B or B2B2C product or service, there are often several types of stakeholders within the prospective company you will engage with during the sales process. You will need to adjust your approach depending on the motivations of each stakeholder you encounter as you attempt to move up (and sometimes down) the organizational chain.
Who: CTO, product manager, or someone who understands the technical complexities behind the scenes. “Technical” isn’t limited to ones and zeroes. It can also include clinical, legal, and regulatory issues (e.g. HIPAA compliance).
Role: This stakeholder will evaluate potential options through a technical “lens”, such as assessing the ability of a new system meshing with a current one, to determine overall solution viability.
Who: CFO or someone in the financial department who oversees the customer’s budget.
Role: The financial-buyer is responsible for assessing the financial viability of a solution. They might ask questions such as: what is the ROI and fiscal benefits/sustainability we can expect here? Does this purchase fit within our budget? Who’s going to pay for the patient/member/user to use this product or service?
Who: front-line clinicians, nurses, and physicians. These are the end-users within the organization who will need to regularly work with the product.
Role: These buyers are your true customers: they will be assessing how the product affects their job duties and responsibilities. These buyers are typically the most important group to delight in order to maintain customer retention.
Note: it is possible for a single stakeholder to embody all three buyer-types, e.g. Head of Business Development or Director of Clinical Affairs. Identify whatever hat(s) that stakeholder happens to be wearing during the conversation and modify your sales pitch for that role.
- Find out which of these 3 buyers is your champion and who is the decision-maker.
- Build a consensus by appealing to each individual’s motives and pain points.
Lisa Martin (Director of Sales Development, Zipongo) typically launches sales campaigns to focus on large employers and large health plans. Her stakeholders can typically found in the HR departments for these organizations. Lisa will usually target the wellness and benefits contacts within HR, as these are the personnel who are the most likely ones in their organization to champion Zipongo’s nutrition platform to the other stakeholders. For customers of this size, building a consensus amongst the stakeholders in finance, HR, health & wellness, etc. is critical to closing the sale.
Takeaway: Focus on nurturing the relationships you have with your stakeholders and champions. Segment them into different buyer types and address individual pain points.
2) Prepare for a Long Sales Cycle, especially with large customers
Closing sales in B2B healthcare software deals don’t happen overnight.
Health organizations can be large and bureaucratic with multiple stakeholders blocking the path to the primary decision maker(s). The sales cycle can trudge on for months at a time (sometimes over a year) so it is critical to maintain the relationships you have with your stakeholders and champion(s).
A) Shorten the long sales cycle by educating stakeholders
Getting a “yes” from one stakeholder before moving onto the next can be laborious and time-consuming. You can prepare for this process and shorten the time involved by:
- Identifying the bottleneck(s), i.e., any part of the system where patient flow is obstructed causing waits and delays, causing the health organization to lose money and resources; and
- Providing case studies and data supporting your solution to your internal influencers so they can champion your product to the other stakeholders. This can include:
- ROI documentation
- Schedule for timing and planning implementation
- Training support tools
- Case studies outlining the value of your IT solution for current customers.
For Zipongo (a digital nutrition platform), the sales teams encountered a common buyer objection that exercise factored more than nutrition with regards to obesity and other health-related issues. The sales team will respond with data and scientific evidence demonstrating that nutrition is the critical ingredient to health and wellness that supersedes exercise. To document ROI, Zipongo’s case studies demonstrate that better employee nutrition results in fewer people calling in sick and using their healthcare benefits, ultimately saving healthcare costs for the company and improving business efficiency.
Takeaway: Educating the customer about your product is a lengthy process. Speed-up the decision-making process by distributing relevant data to key influencers and empower them to sell your solution internally for you.
3) Prove product-ROI by increasing patient engagement and avoiding readmission rate penalties
There are unique challenges when it comes to persuading health organizations on the ROI of a digital health product. The most common buyer objections aren’t about how much the product costs, but rather how to properly measure ROI.
Under the Affordable Care Act and the HRRP, hospitals are financially penalized for hospital readmissions, i.e. when a patient who had been discharged from a hospital is admitted again within a specified time interval. The logic behind the law is that inefficient health systems should be punished (i.e. motivated to improve) because patients wouldn’t be going back to the hospital if they were being properly cared for in the first place. Therefore, a product that can be proven to reduce readmission rates will generate positive ROI for the customer.
Some surveys suggest that up to 68% of American adults own a smartphone, making mobile apps the perfect tool for hospitals to maintain contact with their patients post-discharge. Mobile apps in this context can keep patients engaged and active in their own care by educating them with health-content, confirming the medication plan, and organizing follow-up outpatient appointments.
Approach: Sell your stakeholders on how a rollout of your mobile app into the customer’s post-discharge operations will reduce patient readmissions, potentially saving them millions in HRRP penalties.
A) Mobile apps can boost patient engagement
Traditionally, the product model for the healthcare industry is built around therapeutics (drugs, treatment, and therapy). Also, healthcare systems are typically constructed upon dated infrastructure and can be slow to change due in part to compatibility issues with these legacy systems.
However, health systems cannot ignore the fact that society as a whole is becoming increasingly dependent on mobile telecommunications. Healthcare professionals are also more reliant than ever on mobile devices to perform their work, from accessing patient health records to making clinical decisions at the point of care. The timing is ripe for startups to market and sell their mobile solutions to health systems anxious to modernize.
Again, the goal here is to focus on readmission penalties and how reducing readmission rates will generate positive ROI. Getting patients to engage or play a more active role in their own care will should reduce the likelihood that they will return to the hospital with the same (or more) health issues. Convince stakeholders that this type of engagement can be achieved through mobile technology and software (instead of non-scalable, face-to-face interactions in a doctor’s office). Give your stakeholders relevant case studies and data supporting your solution.
For example, Welkin Health sells to pharmaceutical companies (e.g. drug manufacturers), payers in the healthcare system (e.g. health insurance plans and companies/employers), healthcare providers (e.g. big health and medical systems such as hospitals), and medical device companies (e.g. chronic condition implant devices).
A sizeable proportion of the stakeholders and decision makers for these customers have been operating within a brick and mortar environment for most of their careers (usually anywhere from 10–30 years). These doctors, nurses, and clinicians are accustomed to driving engagement with their patient populations in a face-to-face setting. This is unscalable and economically unviable for health systems operating under value-based care. The challenge for Welkin is convincing the care team that telemedicine works to drive not only engagement but also desirable patient outcomes.
Takeaway: As the healthcare system moves towards value-based care, health systems are looking for solutions that boost patient engagement, yet healthcare culture is biased towards traditional therapeutics and face-to-face interactions. You can get over this obstacle if you present data that proves your product 1) will enhance engagement and 2) has positive ROI.
B) Proper education for channel sales.
Another challenge lies in channel sales, where you sell your product to vendors who then use that product as a supplement to sell their own product. In addition to understanding the use case, be mindful of the end-customers’ pain points that the vendor is trying to resolve — knowing all of this information will allow you to properly frame your product to the vendor in the most relevant manner. The channel re-seller has to be confident and empowered with knowledge of what the supplemental product is capable of so they can incorporate it into the sales pitch of their own product.
In the same Welkin Health example, let’s assume they are selling their product to a medical device company who manufactures a machine that measures a the blood-glucose levels of diabetics. In this specific user-case, that company is purchasing 1) Welkin’s chronic disease management platform and 2) access to Welkin’s diabetic health coaching staff. The medical device company intends to use these Welkin components as supplemental features to be included in their blood-glucose machine package. Therefore, Welkin will need to do the following in order to close the deal with the company: 1) learn the pain points of the end-users ie. the diabetes patients who will use the blood glucose machine; and 2) educate the company on how the Welkin platform and Welkin health coaches, in tandem with the blood glucose machine, can help address and rectify the end-users’ pain points.
Takeaway: In a channel sales deal, you will have to train your partner on how to re-sell your product within the partner’s specific use case. Learn the pain points of the end-user and teach your partner how your solution addresses those pain points.
4) Listen to your early adopters if they ask you to iterate or pivot.
During the process of developing and rolling out an MVP, many startups will eventually have to decide whether to make changes to their product. To iterate or not to iterate? To pivot or stay the course? Making the correct decision at these crossroads could very well determine whether the startup will survive or fold. Almost all of the companies I’ve spoken to have made some sort of changes to their product (and ultimately to the direction of their company) based on feedback from their early adopters. Some of these moves turned out to be potential company-saving decisions in hindsight.
Smart Patients and the clinical search engine
When Smart Patients first started, they began developing on an oncology peer-to-peer support platform. Their early users were patients in the cancer community, these patients asked Smart Patients to develop an alternative to the government’s clinical trial database. Cancer patients who wish to find and enroll in clinical trials offering new cancer treatments often run a search through this database, which is not user-friendly and difficult to navigate.
“They asked us if we could fix that website,” according to CEO Roni Zeiger. “Of course we couldn’t, it’s a system run by the government, not us. We were creating a conversation platform, we didn’t plan on recreating what the clinicaltrials.gov website was doing.” However, these early users were persistent in their requests for a better alternative.
So in their first year, Roni and the Smart Patients team took a big detour from building their conversation platform and created their own clinical trial search engine, which was basically a better, more user-friendly version of the government’s website. Smart Patients integrated their new search tool into their conversation platform, earning the loyalty of their early users, then went right back developing their original product as planned.
Welkin Health and showcasing their mobile app vs. their SaaS platform
In Welkin Health’s early days, their first product was an iOS-only smartphone app built for diabetes health coaches to help them educate their patients about the disease.
As usage of the smartphone app increased, Welkin’s leadership discovered that their users wanted to be more efficient with their time and delivery of education. Therefore, as a result of paying attention to their early adopters’ needs and pain points (the diabetes educators), Welkin developed their current-day patient management platform, which has become the central piece of value in their product.
This platform would not exist today if Welkin’s leadership had not paid attention to their early users’ needs.
Zipongo’s conversion from a B2C business model to a B2B2C
Zipongo’s change in their business model was more due to the type of product they were selling rather than explicit demand from early adopters. Their nutrition management platform was initially designed to be a B2C solution but they discovered that in order to progress, they needed to focus on enterprise and B2B sales instead.
The change was needed for several reasons, both directly related to the issue of reimbursement: 1) the Zipongo program is costly for the general consumer who would probably have to pay out of pocket; and 2) smaller employers usually don’t have wellness programs to absorb the out of pocket cost of Zipongo for their workforce.
As a result of this business model switch, Zipongo has expanded their product offerings and added more functionality to their program. For example, their B2C version delivered food options and choices around the user’s home only. In the current B2B model, both at home and outside of home (ie. around work) food options are provided. Further functional build-outs Zipongo has implemented include restaurant options, grocery store discounts, and other incentives as well which are all aimed at helping their users make healthier food choices.
Takeaway: The lesson here is quite simple — listen to your early adopters and user base when they tell you to change.
5) The definition of engagement: paying customers.
Patient engagement has been a popular, yet somewhat misused, buzzword in the the healthcare industry. A singular, universal definition for this term doesn’t exist because there are many different degrees of so called “engagement.”
Here’s a definition courtesy of Healthcare IT News that makes sense: “Patient engagement [is] a concept that combines a patient’s knowledge, skills, ability and willingness to manage his own health and care with interventions designed to increase activation and promote positive patient behavior.” The article goes on further to state “Being engaged suggests involvement in some sort of activity. Patient engagement would thus require activity on the part of the patient.
If a provider offers a patient portal or similar technology and patients are not actively involved in their use, can we really call this patient engagement?”
This concern was echoed in several of my interviews as well.
Ryan McQuaid (CEO, PlushCare) was specifically concerned that some chronic condition management tools on the market are experiencing the patient engagement issues alluded to earlier. “Often times, apps are developed with the assumption that patients will engage with them. If they’re not using them, then they’re clearly not effective. Patient engagement is a huge failure here for some programs, the numbers are terrible.” There’s this deceptive notion that just because an app has users, those users are actually behaving and acting in a way to positively impact their own health.
To further illustrate this point, Jamie Morganstern (Director of Operations, ConsejoSano) notes that telemedicine platforms have very low levels of engagement and utilization, in the 2.5% range. In contrast, ConsejoSano’s response and engagement rate from Fender Guitar (Corona, CA) with 300 eligible employees is in the 15% range, which blows the industry norm out of the water.
However, ConsejoSano is a unique product because their end-users simply don’t have any other options — there really aren’t any other healthcare-system navigation and management tools on the market that support Spanish speaking employees. If a mere 15% engagement for a product that has its market cornered is considered phenomenal, then this proves that there is an engagement issue with consumer healthcare apps.
So what’s the lesson that startups can learn here? As healthcare moves away from a fee-for-services system and into a value-based model, patients are becoming more responsible for their own health decisions. For healthcare businesses to remain competitive and profitable under this new value-based paradigm, stakeholders are constantly looking to optimize engagement from their patient populations.
Takeaway: Healthcare solutions that drive true engagement and meaningful patient action can increase their sales by distinguishing themselves from the rest of the pack with data that demonstrates value to potential customers.
☆ I’m a Business Development/Sales/Regulatory Compliance professional at Tradecraft consulting for a bunch of awesome startups. If you’re interested in working with me or just want to say hi, shoot me an email at firstname.lastname@example.org
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