The Bottom Liine Ep. 11

Tying marketing attribution to lifetime patient value, with Keith Jensen

How effective are your marketing channels and campaigns at driving revenue? Keith Jensen is a 20-year marketing veteran working with healthcare groups. Today we discusses his methodology for reporting marketing ROI based on lifetime patient value. Join us as we dive into his tech stack and processes.



Ken: All right. We’re back on the Bottom Liine today. We’ve got Keith Jensen. We’re going to talk about marketing metrics, tracking performance through the funnel, maybe hit a little bit of HIPAA challenges. But let’s let our guests quickly say hi. Keith, do you mind giving us an intro? Tell us about yourself.

Keith: Hey, this is the worst part. Let’s skip through this. How about we just say I’ve been doing marketing for 20 years and worked with a lot of companies. So excited to talk about this stuff.

Ken: Awesome. Beautiful. You know what you’re doing then? Cool. Let’s talk specifically for health care companies, right? Because that’s why we’re here. Obviously, marketing and capturing the marketing attribution, tracking that through the funnel. That’s why we’re here today. So can you kind of just give us a primer on how are you tracking marketing attribution, generally speaking?

Keith: Sure. So I’d say what I’ve mostly seen in the past is that marketers are tracking it through conversion data, forms, calls, and then ultimately saying, Hey, we spent this amount of money, we got this amount of calls and they have. Usually there’s some kind of metric in there that says or formula that says, you know, hey, if the call lasted more than 3 minutes, probably a patient. We’ll consider 80% of those converted.

If it lasts between two and whatever, three, then it’s 60%. That’s one way that’s been done. There are more complex ways which I prefer, which would be actually if, let’s say you have a call tracking platform similar to a Liine you’ve got the phone number, you do dynamic number insertion on your website. Someone calls the call platform, the call tracking platform knows that it came from search engine marketing or organic based on the UTM parameter.

Then you’ve got a phone number and they called in through a phone number. Or if they filled out a form, they gave a phone number. Right. So now you have that piece of data. If they maybe filled in online form, you potentially have an email address. Then ideally within a HIPAA compliant platform, you would match up those phone numbers and email addresses to the actual data from your EHR, EMR ,point of sale system, whatever you’re calling it, right?

The data, the system that you’re your clinics or locations are actually using to collect patient information. Ideally, what I, what I typically like to do is you can just have summary level data come out of your EHR. Typically it’s what I do is one row per patient. So you got like a patient id de-identified, nothing that could identify the patient.

Typically an encrypted phone number. Sometimes you’ll get four or five phone numbers. You have a cell phone, a home phone, whatever, whatever they’re collecting at the location. And then you run the matching to say, Hey, we got this phone call from search engine marketing. Did it show up? How many times did they come in? What services that they get?

And then you apply an actual revenue. You know, in some cases it might be a reimbursement model. We expect that on average we’d be reimbursed $200 for a visit like this. So you apply some kind of revenue based calculations on there and then you tie that all back to the ads. And a lot of times you can if you’re tracking through like a like a Liine and I think others, you know, the CallRails and the Call Tracking Metrics might have this capability, too.

But if they’re capturing a UTM parameter, you’re typically capturing the actual ad campaign that you served. So when you do it this way, you can actually tie back how much revenue did we get from this specific ad campaign and how much money did we spend on it, and what’s our CAC? What’s our CAC to LTV, Right? Ultimately, what you’re trying to figure out with health care is how many times does somebody have to come back in order for you to be net positive or profitable on your ad spend?

Because in a lot of cases you might spend $300 or $400 to get somebody to show up at your door, right. To come in for a visit and your reimbursement might only be 200 bucks. By the time you pay the provider, you might be netting 50 bucks. Right. So how many times you have to get that person to come in in order for that cost to be positive?

And you might it might be three months, you might find out that the lifetime value of that patient is only $150 in which case this isn’t worth it to do these ads. So that’s kind of that’s what I mean when I think about the through the funnel metrics.

Charlie: One of the things I just heard you say, let me back up. Most of the practices that I talk to want to have everything you just described in one system. Well, why isn’t there a platform that just does all this and connects it? And so the way you just described it was very simple because it’s ultimately straightforward. But there’s a couple of different platforms that play there.

And you’re also pulling data out there, anonymizing it in certain situations. So there’s no PHI in there. But how would you I mean, it sounds like you just have to have multiple systems that you’re using and there’s not one platform that’s going to do all this, right?

Keith: There’s not one platform, but it doesn’t have to be as many as you think to do what we just described. So you’re always going to have a whole bunch of platforms. You might have a a Hotjar on your your site that’s that’s looking at CRO and then you might have a tag for something else that’s looking at meta information, whatever that is.

But for this for this really, if you’re talking about like, say, Google ads, which is a large amount of spend typically with with health care organizations, really what you need is you already have Google ads. You need.. and a lot of people there’s a whole thing going on now with the GA4 Google Analytics being non HIPAA compliant, People are switching to other platforms where they can sign a BAA.

But you’ve got one of those you’ve got your GA4 if your legal team isn’t really caring too much about the concerns there or you’ve got your, you know, Mixpanel or whatever else that is that you have your BAA. But you have some kind of pixel that is is tracking. The thing is you really don’t need that as much as you would think.

What you really need is the tracking the pixel on your site from the call tracking system that’s going to swap the phone numbers – ideally have forms embedded on your site and potentially an API if you have an online booking tool that sends all that data into your call tracking platform. So now you’ve got your call tracking platform that knows these are the people that called or filled out a form.

What I do like about Liine is that the API does go through and says, Hey, these are booked. So the nice thing there is that like you can believe that a majority of those I mean there might be an error rate, you know margin margin error there but it’s low.

So. So you go, okay, he’s booked, but okay, So we’ve got one platform there. Then you’ve got your for EHR. You already have that. So that’s not a new platform. That’s that’s your source of truth for who came in and how many times they came in. There’s definitely a report you’re going to have to build there that you’re going to have to export or have an API, and to pull that data out.

The third platform is probably the most important one to do the actual math. I like as a platform out there called Corral data. And what I like about them is they have integrations with a lot of these systems already. Some EHRs. If they don’t. They can build it. A lot of times, your EHR, they’ll actually give you a Snowflake or other Azure database that they’re just like every day dumping into, which is where they’re running the reports.

A lot of these EHRs, most people in health care know, they’re pretty antiquated and they don’t they’re not a product led organization typically. So they’re not coming out with new features all the time. So you need something like a report or a table that is summarizing the patient data, but that should not be too difficult. Then you can pull in the phone numbers and that called from Liine or from call rail or whatever you’re using, pull that data in.

That’s going to tell you the ad campaign that they called from whether they came in from the channel, you know, direct organic referral, etc.. Then you’ve got your EHR data that comes in. Corral, does the matching and can apply all the revenue. What I’ve done a lot of times is I’ll connect Corral to a Google sheet where we have variable things where I go, I can just manually go, you know what a reimbursement change.

So if if a location is in South Carolina, change reimbursement for this care type to this and it just updates in Corral so the math can be dynamic doesn’t have to be hardcoded, you could build that into the variables in the math and do a Google sheet that connects in. Corral can do all the mapping and show you all of the data to say, yeah, this is what your CAC is, what your LTV is, and then the last thing you really need is Google ads, which feeds directly again into Corral and the the Liine data that told you this phone number called from this campaign that once that’s in Corral now Corral can match that campaign data

up to the spend that came from Google ads. So now you think about you you do have one system that has spend data from Google ads, cost per click, all the good stuff Google Ads needs to know, then it has how many people called from them, Right. What were the what was the conversion rate on that? And in Liine’s case, how many booked?

And then you’ve got your EHR data matched up to say how many showed up and how many times they come back and what was the reimbursement rate for those types of visits and pull all that together. And now you have your CAC to LTV and that is what truly I think is what a good marketer would want to make the decisions that they need to make about what’s working, what isn’t.

Charlie: Makes a ton of sense. And if somebody was going to does not doing that now which most people are not and they were going to start doing it, it’ll depend on their specialty and their practice. But you know. What I’m thinking about his lifetime value, right? So. So how many how long do you have to sort of track this to where you really understand enough to start optimizing the campaigns?

Again, it’ll be dependent on the nature of the services provided. But how how would you help someone think about that if they were just getting started? They weren’t sure maybe what maybe how many visits somebody has for their services.

Keith: And it so well, tough to the end of that question made me maybe think that you were saying if you don’t know if you don’t have the EHR data to know how many times people are coming back.

Charlie: I guess they would know because they’ve gotten an EHR. So forget that part.

Keith: So let’s say they so yeah, so now let’s just say they know they have all this data that we just. Yeah, right. What you’re probably going to find out if you just start measuring today, What you’re going to find out probably is that well we spent (making it up) $20,000 on Google ads this month. We got X amount of bookings and that only brought in $5,000 of revenue.

Uh oh. Like, don’t panic. Right? Most most things don’t don’t bring back the revenue with a profit immediately. With health care services especially, people are typically coming back. It’s a little bit harder when you have annual based services. You know, you’ve got a gastroenterologist or you’ve got even dental is is difficult, right? Because like people don’t you know, people come it’s supposed to be every six months and not everyone does that you know.

Meanwhile you try to leave a dental practice without booking your next visit and they basically tackle you. Right. They’re really good at the forward looking component of things. Probably the best in all the health care verticals. But yeah, ultimately you have to figure out you have to just let the calculation run to see how long is it going to take, Is it going to be two, three, four months before those do those that $5,000 that you originally brought in makes it over $20,000 and it should, Right.

If you are bringing patients in, no matter what the the number is that you’re bringing them in the cost per booking, If they come back enough, eventually it’ll get there. So the beautiful thing about this type of of build once it’s it’s built is that it updates automatically. So the longer you get from the day you started tracking that number just keeps racking up because people come back more and more times ideally and eventually you can see it might be two months or it might be nine months, but at some point you’ll see how long it takes you to recoup that that money.

If you get to the four or five month mark and you’re still the first month is still below, you might start getting worried for sure. But I think it all just depends on on whether it’s the cash based business or, you know, insurance and reimbursement, which also could be variable based on the state, which again, you can plug all into the Google sheet and just modify it up there.

Charlie: Yeah. Yeah. I think anybody who’s starting like this, step one, in addition, everything he says, just like also just look at your historical data in your each hour of the average number of visits per patient that you’ve already had, regardless of where they came from as a starting place. And just know that and then you have at least a point of reference to understand a timeframe you should be expecting to some extent of when you’re going to get a return on the marketing dollars.

Good stuff, man. Simple stuff. What else you want to talk about?

Ken: So we talk about HIPAA quickly because I know that’s kind of the big obviously the big hurdle where changes sort of things are doing in marketing. How does that sort of impact what you’re doing versus other industries or especially like pixel tracking things like Facebook which rely on pixel tracking to improve what their algorithms do? How do you get around all of that?

Keith: Right. Well, look, I’ll repeat what people have told me because I haven’t done the research to see if this is a true statement or not. Right. But what I have been told is that there are, you know, lawyers trolling, looking at websites going, ooh, this the health care site. They’ve got Google Analytics on there. I’m gonna include them in a class action lawsuit because we know that Google Analytics will not sign a BAA.

And essentially what they’re saying or positing and who knows if this is accurate or not. I’m not a lawyer. What they’re saying is that by allowing Google to have their pixel on your site and you having no agreement in place with Google as to what they can do with the information that they capture, even though you’re not letting them capture things like name or let’s say they don’t fill out a form and it’s like name, email and you’re not letting Google have those.

Still, Google has that person’s IP address and that IP address. They know the through, you know, virtually every other site in the world having Google Analytics on it, they know where they’ve been. They know a lot about that person right? So by you basically allowing Google to know that this IP address hit your health care services page and went to a page about knee replacements.

Right. Well, you kind of told you kind of, you know, violated HIPA is what they’re saying by allowing Google to be able to connect those dots. Now, who’s to know who’s to say what Google can do with that information? They can go sell that information to a pharmaceutical company that wants to advertise to people with knee pain. Right.

So that is where the problem comes in. And it really is up to each marketer and legal team to decide how risky they believe or how at risk they believe they are. If if you are if you believe you’re at risk, then there are platforms out there. I think Amplitude’s one, Mixpanel,, they’ll all sign a BAA with you, a business associates agreement, essentially saying that we won’t do anything with your data that you don’t want us to.

You decide where your data gets sent. So so that’s one component of the pixel tracking. Going back to what we were talking about in terms of the through the funnel, I think it all gets down to again, the level of comfort your legal team will have with the systems you’re using. You’re going to have BAAs as a healthcare organization with virtually every with every system that touches your data.

So, you know, any Liine or any other call tracking, you’re going to have a BAA in place with a Corral data where you bring everything you’ll have a bar in place with. And then the majority of those companies will also be HIPAA compliant, which is kind of a self-certification, but it’s saying, Hey, we were secure enough that we feel good here.

We’re not going to run any risk for violating HIPAA or breaches. So that’s essentially the way. So now the level of information that you send into these platforms, for instance, the corral data, you may decide, well, I don’t want them to have a name, phone number, email, right. Really, all they need is the phone number. So what you can do is out of your or you run a script that encrypts the phone number.

This basically runs it through this huge algorithm, right? That that takes all these numbers and multiplies them and does all of a sudden there’s a there’s a key to that algorithm to decode it, to get it back to a phone number. You send that data into Corral and potentially you get the same, let’s say, encrypted encryption happening from your call tracking.

You don’t even have to necessarily decrypt it. You get phone number. You can match up the encrypted numbers and say, okay, these match. So now we know. So there are definitely ways to not pass HIPAA related data into platforms and still be able to do this kind of calculations. It just takes a little extra work right now.

Charlie: It’s interesting that it’s been I mean, like you said, it’s because of the lawsuits that are going on. But I mean, this is wasn’t a thing until three or four months ago. Right. And some big groups are getting legal trouble and then everybody’s talking about it.

Keith: So it’s like that too good to be true thing, right? Everyone is like, man, Google great. They’ve given us this pixel that tells us all these cool things. And Google’s like, Well, yeah, yeah, good. Look, I’m monetizing this on the back end with everyone else who wants to advertise. So the people who came to your site. Totally. So it’s not exactly as simple as that, but it all boils down to, yeah, if, if they’re interpreting IP address as part of PHI or PII, then yeah, you are basically giving away PHI by allowing a Google pixel on there.

And that is a more recent school of thought. So again, I’m not going to say that it’s a it’s a true statement because again, I haven’t seen any of these lawsuits, but I have been told that they exist. So it ultimately comes down to how risky or how at risk you believe your organization is.

Ken: Well, key takeaway for today is if you’re just tracking the initial sale, you’re missing out on the actual performance. Lifetime value, Get that data.

Charlie: Yeah, and most people are just tracking calls or clicks, man. You got to go deeper in that, no doubt.

Ken: Yeah.

Keith: Easier, easier to make business decisions when you go deeper.

Charlie: No doubt.