We interviewed Brandon Betancourt of Pediatric Inc and Salud Pediatrics about his thoughts on what in means to innovate at the pediatric practice level today. His insights prompted a great discussion on micro-innovation and how the simplest changes can often produce the best results.
Susanne: Brandon, Thank you for joining me today to discuss innovation in healthcare. When thinking about who to talk to about innovation at the small pediatric practice level, I thought there’s no better person than Brandon Betancourt — you write a blog, you manage Salud Pediatrics, and you’re just the sort of person who can’t help but think of innovation when tackling problems and challenges.
I’d like to talk to you today about micro and macro innovations, big and small. What does that look like at the pediatric practice level where you have 2 doctors and 1 nurse practitioner? What does that conjure up in your mind in relation to all of the things that you have to deal with daily and weekly there?
Brandon: Really, when I think about innovation one of the things that first comes to mind is frustration quite frankly. If you look at some of the other industries and you look at the advancement that we’ve seen with smartphones, web applications, and apps, — we are really, really far behind [in medical practices]. A lot of the cool things that many people are doing aren’t accessible to us — we’re limited by a number of things. One challenge is finding the time and resources, but also in order to execute some of these innovations in a way that serves our patients, the technology that is available to us is locked up, or the functionality isn’t there. I’m talking specifically about our EMRs and our practice management systems. That’s the first thing that comes to mind.
Having said that there are, of course, a lot of things that we can do. I’m always looking for ways that we can use innovation, and really what I’m talking about is innovation in relationship to technology.
I’m always thinking about what is available to us. What can we utilize to not only make our jobs easier, in terms of patient flow, or automation? A lot of tasks can now be automated to some extent. There are also great opportunities to reach out to patients. Patient engagement is now largely taken care of by technology.
Susanne: I hear you saying a couple of things. One being that if only the technology were better we could innovate faster and smarter, but there are limitations in terms of the ability to innovate due to the constraints that you’re experiencing with EMRs and practice management systems. I hear that loud and clear. Then, of course, there’s regulation that plays into that too. You have to be so mindful about protected health information. On the other side, I’m also hearing you say there’s great opportunity to engage with patients in a different way, utilizing what technology there is available or some of the exciting new technologies and platforms that are springing up around this idea that patients are becoming much more involved in their healthcare.
Brandon: Yes, absolutely.
Susanne: How do you tackle that proactive patient engagement? I know you have a background in marketing. Do you find that it is as easy to engage in marketing and engage with your patients in the practice management industry as it is in other industries?
Brandon: I think it’s a lot more difficult than traditional marketing. It’s not like you can just create a promotion, a “2 for 1” sort of deal, or “3 months free” if you sign up. There are all these incentives that traditional businesses can offer to create customer loyalty and have people coming back [for more]. In the medical field, we don’t have that, right?
That said, one of the marketing advantages we do have is the ability to communicate more on an emotional level. People love their pediatricians. In terms of specialties, I think we pediatricians have one of the best relationships with patients — with maybe the exception of the OB/GYN crowd. We spend many years with a family so there’s a level of trust and even a level of friendship that gets created over the years. As all pediatricians know, you don’t just have a relationship with the kid; you have a relationship with the family.
It’s not just a stuffy nose, or a sore throat. Some of the challenges have to do with social issues. My wife Joanna, the founder of Salud Pediatrics, was recently explaining to someone that there is so much more to pediatrics training than just the scientific and medical training. There are all these social components to consider, such as advice about the effects of stress on kids, under performing because of emotional issues, and things of that nature.
My point is, you can capture that emotional offering that pediatricians have that a lot of other specialties may not. One of the best ways to explain it is by comparison to the non-profit world — they’re very much in the same category as us. They can’t offer any type of traditional or retail-type promotions. What do they do to make their appeal to people? They do it from an emotional level, and that’s what we try to do. When we think about what we’re marketing, it’s not just the usual “We’re open weekends,” or “Accepting new patients.” Of course we’re accepting new patients, why else would we advertise? There is that bond or a connection that we have with patients that we carry over to the marketing and advertising side.
Tying it back to technology and innovation, the web has afforded us the opportunity to do some amazing stuff — from a marketing standpoint, from an innovation standpoint, from a practice management standpoint, really from any way you want to look at it. The web has really democratized communication. Anybody with a voice can essentially communicate to a pretty large crowd. That wasn’t accessible to us just a few short years ago. There are various ways of doing it: through blogs, through Facebook, through some of the other social media platforms that are out there. And there’s new ones coming out all the time. Just last month we were with Dr. John Moore and he was talking about Snapchat. It’s important to keep an eye on the new things that young kids are doing.
Susanne: What’s important is really that innovation doesn’t just need to be technology. You’re really saying that the technology can be the tools. That can be the means to make the connections but the innovations here are really understanding who are you reaching, and what do they care about. You really can’t create that ‘stickiness’ with your patients if the message is just generic.
To your point, an ad that says, “Accepting new patients,” well of course you are. What is that actually saying? Where’s the connection? What is this even about other than “Okay, here’s a practice, I’m looking at an ad for a practice”. I think what you’re striving for in terms of tapping into that relationship is to say “how can we connect? How can I help you?” How do we build a relationship that is going to be rewarding and sustainable? I think, particularly, in pediatrics, as you say, you have an opportunity for a relationship that’s very different from many of other specialties.
For a lot of other specialties it’s a single events where a patient might need to go to, say, a dermatologist to have something removed and it’s one and done. You may not see that Derm for another 5 or 10 years. With pediatrics, you’re really close to that family, you’re seeing that child and that family on a much more regular basis. The innovation comes into how you develop and nurture that relationship. How do you first initially reach them? I really love what you’re saying about how you tap into that. The relationship is what it’s all about, not the services you provide, and not about the EMR that you have, but really it’s the connection. It’s actually about forging that bond between you and the patient.
Brandon: Right. One of the ways that we’ve achieved that is with video. On the web, people tend to prefer a video over reading a long article so I knew that we wanted to have a video on the site. We wanted to tap into who we are because that’s one of the things that distinguishes us and sets us apart from other practices. We asked ourselves, “How do we capture that in a video?” We thought about it and the answer was us! We need to feature us. My wife Joanna — known around the practice as Dr. B — she’s the matriarch of the practice and people know her. She’s been here the longest, and she’s the one leading the practice. The idea was to capture her in her everyday routine. With all of the tools available to us today we can do that. It would’ve been very, very expensive to produce something like that just a few years ago.
I found a young guy that does a lot of video productions for the church that we go to. I said, “Hey, are you interested in doing this project?” and he said, “Yes.” I told him exactly what I’m telling you right now, “This is what I want you to capture, this is what I want you to do.” Then, we put Joanna in front of the camera and created a video that really showed us and what we’re about. If you look at the video, you’ll see what I’m talking about. It’s nothing fancy but it works. We also brought in a couple of patients who talked about their experience coming to the practice and we highlighted the 2 other providers a little bit. We also show pictures of the kids and staff having fun to capture these good feelings.
Of course we’re accepting new patients, of course we want to take care of children, of course there’s quality service. I don’t think that we need to say that in the video because it would be like a restaurant saying, “We serve fresh food here.” You shouldn’t need to make that point, right?
There’s an example I always use that our team is probably sick of hearing. The Prevnar that we give in our office is no different from the Prevnar from the doctor down the street. It’s no different. I’m not meaning to over-simplify pediatrics. There’s a real art to it but in terms of the medicines that we give there’s really no advantage, our medicine is not better than any other practice’s [medicine].
Susanne: Exactly, there are standard things that don’t need to be highlighted. They’re going to be standard in any practice.
Brandon: My point is we can’t really compete on product differentiation because there’s nothing there. However, we can compete by distinguishing us from the rest of the crowd. I think that’s becoming even more important because a lot of the things that used to be part of what pediatricians did have become so standardized. In fact, you don’t need a medical degree in order to provide some of those services, like what we’re seeing with the retail clinics.
Now, it becomes more of an issue to make that distinction about what is different about us. We’re feeling that pressure now. It’s very difficult for the average person to identify the different of levels of care and their importance. At the end of the day, the patient goes to the retail clinic and gets the Amoxicillin that we would’ve given and they walk out. As far as they’re concerned they’re thinking, “What is the difference for me going to a doctor’s office and going to a mini clinic if I’m walking out with the same prescription?” Not to mention, it’s more convenient because they can fill their prescription and pick up the milk at the same time. Now, it becomes even more of an issue to innovate not just in terms of how we deliver services but also how we engage, how we connect.
Susanne: I think that engagement piece is so key because that is what is going to lead that patient to a decision. Are they just going to stop by the mini clinic for fast, convenient service and to pick up the milk? Or, are they going to call their pediatrician and ask, “Can you squeeze me in?” because they’d really rather come to you. If they don’t feel that connection, and it’s just viewed as equivalent to what a minute clinic can provide for them then all bets are off. You’re going to have that patient flip-flop in between the two. As you say, you’re not competing on product. You can get a vaccine from both. What is the difference to the patient? It all comes down to the relationship, the experience.
I’m a big fan of the video on your website. When I first saw it I thought, “That is innovative. There are so many practices that just don’t have that.” You’ve managed to convey the true spirit of Salud Pediatrics and what the quality of service, and what the experience, will be. I think that is really big. In this era of big data and lots of choices, your competitor is not the other pediatric practice down the street, it’s the retail based clinics and the employer on-site clinics. You’re also competing with tele-medicine and other opportunities. The industry has become radically different and if you’re not truly representing what it is that sets you apart and continually innovating, what does it come down to?
Brandon: Exactly, it’s not simply about the offering. If you look carefully at what we say in the video, Joanna mentions that all 3 of the providers are mothers, and they’re working mothers with small children. So there’s that emotional appeal, a point of connection. A working mother sees that and thinks, “Dr. B knows medicine but she also understands what I’m going through.”
Susanne: Right, it resonates.
Brandon: Exactly. That’s what we’ve tried to highlight. The next piece is the education and the engagement part of it. We’ve done some other videos that we use on Facebook where I ask Joanna, “Hey, what’s going around these days?” and she says, “Hand, foot and mouth disease.” She’ll describe the symptoms, and explain what you’re supposed to do, when to call us, and so on. We made that video in our living room and I edited it right on my iPhone. I didn’t even use a computer.
One of our biggest challenges is getting adolescents in for their wellness visit — that’s a common problem for most pediatricians. I wanted to motivate that age group to come in so I posted a simple note on our Facebook page saying that, “Did you know that pediatricians are trained to see children until they’re 21 years old?” That post got so many likes and responses. People had no idea that pediatricians see kids that old. Some of the comments we received really confirmed that a lot of people didn’t know that, “Oh, little Jimmy isn’t so little anymore. He’s about to go to college, but he’s not comfortable going to see our GP yet. He’s going to be so happy to hear this!”
That was a point of pause for me. I thought, “Wait a minute, you don’t know this?” I realized there’s a disconnect here, a knowledge gap between us and our patient base. Of course, my next thought was, “What else don’t they know?” As it turns out, a lot!
Susanne: Right, you know your business inside and out but they don’t. So if you don’t tell them about some aspect of the practice, then how can you expect them to actually know about it?
Brandon :Yeah. I see it when people call the office to make an appointment. I pick up the phone a lot to help make appointments. I do it for several reasons, partly just to help out but I also do it because it gives [me] a good sense of what’s going on. A lot of people call and they’ll say, “I need to make an appointment for shots.” In my mind, I’m thinking that yes, getting shots is part of the preventive wellness but it’s just a portion of the wellness visit. In the mind of the patient, they’re just coming in for shots, which tells me that they don’t really understand everything else that they’re coming in for.
Of course, the flipside is true too. If you tell them that they need to come in for their wellness visit they ask, “But we don’t need any shots so why would we come in?” It’s clear that they don’t know what’s really involved in a wellness visit. So, we have to tell them. It’s our job to make sure they know. We have to explain that it’s not just about shots or treating an earache. We go through all the developmental milestones, we talk about proper feeding habits, and preventive wellness, we check vision, we check hearing, we check the weight. And it’s not just about the physical examination — we talk to the child and ask if everything is okay at school. Are there any social issues? It’s extremely important that we communicate what a wellness visit really is so they come to recognize the importance and the value in choosing to come here.
I like to use the car analogy. Most people go and get their oil changed and have a tune up because they know that the maintenance is going to help their car last longer. People don’t realize that it’s the same with their bodies. Most people are aware that their car needs tire rotation and I think that’s because auto mechanics have done a better job of saying, “Hey, maintenance is very important.” We can learn from that.
Susanne: That’s an important point. Do you find that, in general, the population is becoming better informed? We see other pediatric practices doing some of the things you’re doing and there is more talk about pediatrics in the media. We also see the AAP doing more promotion. Do you see this as reaching a critical mass in terms of how patients perceive the role of pediatricians today?
Brandon :Well I think we can be a little bit biased. Because of the network of people that we hang out with, you know… the SOAPM folks and the PMI crowd, I think we may be preaching to the choir. A lot of people and groups are doing a very good job in this area, recalling patients and getting patients in for well visits, et cetera but I don’t think the reach is that wide. That said, the AAP have started to “move the needle”. There is a big emphasis, for example, on the flu shot and how important vaccines are and we’ve seen a finite shift in awareness. In terms of just the wellness visit, in general, I don’t necessarily think that we’ve moved the needle that much. Even with all of our efforts, doing recalls and really focusing on that, it’s still pretty difficult to bring people in.
Here’s the thing though, every 6 months we get a postcard that says our dog Maya is due for something at the vet. Those reminder cards have been coming as long as we’ve had Maya. And it’s done really well. It’s tailored to our dog’s age, our dog’s breed, everything. The card will tell us that Maya is due for this, and this, and that, and we always make the appointment. I always find it surprising that our vet is way more on top of my dog’s health than a lot of pediatricians are about their patients.
Dentists have also been very good at reminding people they you need to get their teeth cleaned every 6 months. Now, whether or not people do it, that’s another thing but people know that the standard is you need to get your teeth cleaned every 6 months, and you need to floss, and you need to brush, and so on. I think the dental community has done a much better job in terms of patient recall and retention than we have.
And I’m not just speaking as someone who works in a practice, I’m speaking as a parent too. We take our kids to another pediatrician, outside of our practice. We don’t get reminders from them that the kid is due for a wellness visit. We go because we’re in the business so we know that it’s important.
Susanne: Dentists are really great at that direct marketing, the reminders and constant touch points. Almost to the point that it’s too much at times. I hear from my dentist at least once a month for one thing or another. Even if it is annoying sometimes, the point is they’re always on my radar. I think the question now is, “How else can these things be improved upon?”
In term of your own practice, what do you see next? Can you talk about one or two of the biggest things that you have to be planning for, and maybe innovating around?
Brandon :When I look at the future I’m always thinking about, “Where are our patients?” We need to meet them where they are so [that] we can communicate our message. How do we do that? And once we get them in here, how do we do cool things in the office as well? Using tablets is a great example of how we can update our processes to suit our patients and their families. I still find it crazy that we require people to fill out so many paper forms and that they have to sign their name on every piece. Let’s say a mother has 3 children who visits our practice and she wants to update their address and contact info. She has to do it on three separate forms. That’s just simply ridiculous. My point is that it’s easy to take care of all that stuff with automation and with innovation. Yet, we don’t.
Now, some of this falls on the side of the EMRs, providing this technology so that we can improve these processes. It’s not just, “Oh, we’ll help you code better,” or “We can help you find the diagnosis quicker, or document the chart faster.” It’s also about how do we improve on ushering patients in and out? Especially for the EMRs that don’t cater specifically to pediatricians — they have a hard time in understanding that each patient is part of a household, they’re all connected. So, back to my example of the mom who has to fill in the same information three times over… the software is certainly smart enough to do that.
The good news is that some of the EMRs are starting to offer these sorts of services. But here’s where I see what the big problem is and it’s that doctors always seem to be lagging behind. It’s taken, I don’t know, 5, 6, 7 years for most pediatricians to get a decent website up and running. The problem is that the web has, basically, moved on to the mobile devices. We still need to have that presence of a website but our focus needs to be on mobile. I recently read a fascinating article about the rapid adoption of mobile devices. There is this company that looked over millions and millions of newsletters to see how they were opened. Were they opened on the tablet, phone or desktop? Both tablets and desktop computers were in decline drastically. It was plummeting. Everybody is doing everything on their smartphones.
In terms of innovation, I think that pediatricians need to be thinking about what can be done to leverage this trend — which is almost not a trend, it’s the status quo now — of using the phone as a way to do a lot of stuff. I can think of a lot of things that we could do better with smartphones. If you watch what Facebook and Google are doing and how they’re really focused on mobile, that’s a big indicator of where things are now and where things are headed. This is where marketing is going, there’s no doubt. We need to be on mobile because that’s where the people are.
Susanne: I think what you’re saying is if you look at some of the bigger companies, and look at what they’re paying attention to, you’re then able to pull that down to something relevant in your own practice. I think that’s very wise. I really like that idea of keeping an eye on what the big guys are doing because that’s going to be very revealing in terms of where consumers are going. I love that you’re saying, “Look around, lift your head up, look at what the big boys are doing, and apply that to your own practice.”
Brandon :It doesn’t even have to be Facebook or Google. Take a look at your bank and how people are engaging with them. Nobody goes to the teller or even the website anymore. Nowadays, you can take a picture of your check with your phone and it gets deposited. Just think about that for one minute and then think about where we’re at. We’re requiring people to fill out numerous forms, those forms later have to be scanned in order for the information to be updated, and then somebody has to type all that information in. Somebody, physically, has to put it in. So on the one hand we have the banking industry that’s using mobile to make life easier for their customers and then we’re here on the other side asking people to log on to a web portal that only provides bare bones information. That, to me, is unacceptable.
Granted, we are limited in what we can do and that’s where the frustration comes in on my part. Why are we so far behind? I don’t think we should be pushing this web portal thing. I think that’s just a waste of time because the trend is, clearly, on mobile. At the very least, these websites need to be responsive and mobile-friendly. It doesn’t have to be an app or anything, but the website has to perform just as well as my bank app. Another thing that’s very important to remember is that our audience is always going to skew younger.
I remember reading an article about kids that were graduating in 2015. This group of kids are the first generation to go through high school with Instagram. Instagram came out when they were entering into their junior year and they’ve grown up with the app. What are the implications of that for us? These kids that were high school students, seniors, last year. In 5 or 6 years they’ll be walking into our practices with new babies. They’re going to be our new parents. I think a lot about that. What are we doing today to prepare for this new group of kids that are used to being able to deposit a check without going to the bank and communicating via Instagram and Snapchat?
Susanne: Excellent points, Brandon! If you’re not meeting your patients where they are, then they’re going to find somebody else that will meet them where they are. I think that’s a great take-away from our conversation. I really love the perspective that you’ve brought today. If you want to stay relevant, if you want to compete, and certainly if you want to grow, innovation needs to happen at every level, in any sized business. Thanks so much for the time that you spent with us today and I look forward to sharing your insights with our Viewpoint readers.