Fat funnels, marketing, and doctors that drive customer retention

fruit fresh health doctor marketing funnel

Are fat funnels good, even for medical professionals?

Every smart marketer knows that customer retention is about much more than marketing. So today we’re talking to a head of product. She happens to be Dr. Ruth Guthoff-Rechnagel from Doctor Care Anywhere and, as you can guess from the name, she’s been pretty busy during the current Covid-19 period.

So busy that, she says, her funnels are fat. In this episode of Retention Masterclass Peggy Anne Salz and John Koetsier chat with Ruth about marketing, product, and — of course — customer retention.

See below for the audio podcast, a full video, and a complete transcript of our conversation …

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John Koetsier: Are fat funnels good, even for medical professionals? Hello and welcome to Retention Masterclass. My name is John Koetsier. 

Peggy Anne Salz: And I’m Peggy Anne Salz, and we’re your co-hosts on this show, and every show. 

John Koetsier: Every show, absolutely. 

Peggy Anne Salz: Every show, we’ve got quite a few of them, John. So we’re getting in our groove. 

John Koetsier: I know, I know. It’s wonderful. We do have a special treat today, though. We have, hey, every smart marketer knows that retention is about more than just marketing, right? So today we’re talking to a head of product, it’s not just marketing, it’s also about your product. 

Peggy Anne Salz: Absolutely. And I have to say, I greet this, right, because it’s as it should be. It’s really about, product is the new marketing, right? Retention is the new black. These are the sayings out there, John, I’m sure you’ve heard them. And now we’re going to do it, we’ll get to the real deal, because our guest has a firm grasp of both: Ruth Guthoff-Recknagel. 

Ruth Guthoff-Recknagel: Guten tag.

Peggy Anne Salz: Yes, I did it. Guten tag, absolutely.

John Koetsier: Wow!

Peggy Anne Salz:  Head of product at Doctor Care Anywhere, having seen some amazing product expansion, some amazing experiences also. Because what wouldn’t she want to do in our current times, pandemic times, you know, it’s all about doctor care anywhere we want it, and you have it, Ruth. 

John Koetsier: Excellent. So Ruth is a very special head of product. She’s a former founder, which is always great to have entrepreneurial experience. She’s also a startup advisor.

Peggy Anne Salz: And, interestingly enough, this is the first time I actually heard of this …  this is a B2B2C company. I know they’re out there, but we haven’t had one of them. I haven’t spoken with too many of them. Even more complex, because you’re talking to two different audiences: your audience, your audience’s audience, keeping them on board, keeping them retained, that’s what we’re talking about here.

So welcome to Retention Masterclass, Ruth! Great to have you. 

Ruth Guthoff-Recknagel

Ruth Guthoff-Recknagel, Head of Product at Doctor Care Anywhere

Ruth Guthoff-Recknagel: Guten tag! Great to be here.

John Koetsier: Wonderful. Hey, we have to start with the funnel in the room. What is this fat funnel that you’re talking about? 

Ruth Guthoff-Recknagel: Right. Let me give you a little bit of an explanation [of] what actually DCA does.

So we are a telemedicine company in the U.K. and we’re offering virtual GP-doctor consultations, as well as a diagnostic pathway. And as the name tells you, you can have your consultation wherever you want, and I think that’s a very important point.

Before I get to the fat funnel, I want to tell you a little bit about the product vision, and that will then help you to feel it, so to say. So we are enabling you, our patients, to manage your and your loved one’s health effortlessly, quickly, and appropriately. And by manage, I mean, everything’s on an app. It’s from booking to consultation, you know, it’s everything, even your long term care plan will be on that app. Effortlessly, because you do this out of the comfort of your home or wherever your place of choice is, or you can choose between video, you can choose between telephoning, no travel required; even if you go down the diagnostic pathway, there’s only one visit to the hospital needed. Quickly, because once you signed up, it’s a 20-minute deal to get an appointment. Appropriately, it’s because our doctors really understand what your challenges to health concerns are, and they will recommend the right treatment path.

So, I think the point then if you see this, if you as a patient having this ability to manage your health, this is where the fat funnel started.

So, earlier this year what we had is — and I’m going to show you with my fingers — it was a funnel. We had channel partners, we had companies and people would come in and then the funnel was very thin. And suddenly, due to pandemic, we had a lot of channel partners who wanted to work with us. We had a lot of companies who wanted to work with us. And so we had a lot of people who would go through our funnel from activation to verification, up to the point of booking, and suddenly our funnel was really, really fat.

And this is not only on the consultation side, because people saw that it’s really important to sign up right away to be ready whenever you need care, to have care at your fingertips. So this is why we’re calling this a “fat funnel” because suddenly things were triple the size, [four times] the size, and it’s amazing, 

John Koetsier: It’s a good problem to have. 

Ruth Guthoff-Recknagel: Yes.

Peggy Anne Salz: Exactly. So you started to talk about, I wanted to explore it a little bit more, you know, what happened because of COVID, also just because of all of these companies interested in this at one time. That’s, you know, it’s a great problem to have, to John’s point, but it’s also transformative for your business because all of a sudden it’s a very different dynamic than you were even preparing for. 

Ruth Guthoff-Recknagel: Yes. I think to be very honest, what we were preparing for was the next market extension. So we had built a virtual GP, which was good and amazing, going down the right path. And we had also built the diagnostic pathway and that 1st of April was supposed to be the new, big thing, and come pandemic, so the virtual GP pathway. And if I can explain that to you in a tube map.

So if you have one tube map and suddenly you have lots and lots of people in that tube, and then suddenly the new thing you build, which you thought would bring retention, was empty because we couldn’t send anybody to the hospital.

So that kind of was really positive for us on one side, but the plans we had for the future were really turned around by no passengers for the diagnostic pathway, which now seems like such a … 

John Koetsier: This is not a …  sorry, go ahead, go ahead.  

Ruth Guthoff-Recknagel: This is, so, slowly we now have people also in the second tube line, but, it’s not the impact we thought it would have. 

John Koetsier: This is not a new story for us, because Peggy and I have been hearing this story quite a bit, obviously.

Everybody had their plans for 2020, including marketers and entrepreneurs, and everything changed.

So you had a 3X increase in number of users that wanted a consultation alone. What capacity at your end had to stretch to meet that demand? 

Ruth Guthoff-Recknagel: I think anybody who’s read the book from Jurgen Appelo about Startup, Scale Up, Screw Up, what happens there is that suddenly we had a demand that we had to really get our business ready for.

So a lot of the things we did was new implementations around our routing system, implementations around amplitude, and all kinds of systems that actually need to grow were suddenly something that we needed to tackle at a much faster pace than we had intended. Because any company will get ready for scale, but not necessarily with that speed. And I think that surprised us. 

Peggy Anne Salz: Well, what also made this complex, if you think about this, because you have an ecosystem, so you’ve got all these companies feeding into your funnel. Now you’ve got your head around it, you’re saying, ‘Yes, we have to change, we have to do things differently, we have to get people in the other tube car, right, on the other line.’ But what do you do with them? Because in a way, it’s very tricky.

The B2B2C thing going on here is also saying that your partners, everyone else has to get in with you on that model. You have to optimize the funnel, not just because you can do it and you’re really smart Ruth, I do know that. But everyone else so far — we’ll get to that, because you had that great retention course also with Reforge. So, you know your stuff, but your partners don’t, they didn’t have that course. So how do you sort of orchestrate that? 

Ruth Guthoff-Recknagel: I think we took a big step back into alignment of features. So I think when we initially started as a startup, you’re trying to accommodate things, and we came to the point where we couldn’t accommodate as much anymore so we had to align features. And if you think about channel partners and then the companies and the patients, we also made sure that from a discovery point of view, we did not only talk to the payers as the companies, we also spent a lot of time discovering what our patients want.

So anybody who knows Marty Cagan knows “valuable, viable, feasible, usable.”

And we spend a lot of time on that because also if we understand what our patients want, that gives us the power to then also help sell to the channel partners. So that was a quick learning curve of really making sure that we serve our patients, but also know how to sell to the channel partners.

And I think there’s this risk, the risky assumption tests that you do, but then you also need to find a minimal valuable product and a minimal lovable product. And I think that’s the one that is super important for us. 

John Koetsier: Nice. 

Peggy Anne Salz: I’d like to say something about the lovable product here, John. I mean, if you think about it, isn’t there something here about also the trust of this product. I mean, I’m going here for my consultations. This is the time where, you know, and we won’t be stopping this anytime soon.

So maybe just as a followup to that, it’s one thing to sort of get the partners to understand that they have to do their part and keep that balance, but there’s probably also something in there about the communication to build the trust in the product and keep everyone sort of …  keeping them on the same messaging. That’s going to attract me and engage me as your user and keep me coming back. I’m not going to get this messaging at the beginning of the pandemic and then later on, as you sort of move through your own model, different messaging to me, right? 

Ruth Guthoff-Recknagel: Yes. And I think …  and then you see this with different companies. So lots of them start with B2C. We were lucky enough to do B2B2C, and lucky enough means you need to work with the channel partners and the companies. But I think at the end of the day, what we’re aiming for is that we will, you as a patient, if you’re able to manage your health, then we want you there.

Peggy Anne Salz: Mm-hmm.

Ruth Guthoff-Recknagel: So if you leave, for example, your company and you don’t have that insurance anymore, we want you to be still there and we want you to have the trust and the positive experience, and at least two or three ‘aha’ moments of yes, they can help with anything that’s related to health, go to Doctor Care Anywhere.

John Koetsier: It makes a ton of sense. A question that comes to mind as you’re dealing with kind of hypergrowth that COVID has brought around, is what metrics are you watching? And how has that changed? Has that changed because of COVID? 

Ruth Guthoff-Recknagel: So, no, it doesn’t. It hasn’t really changed, and then tha[t] might be [a] surprise. So we still look at activation. We still look at verification. We’ve implemented now something that is called “Ready to Book,” because there’s a few items that you need to do before you can book, and that’s a new one we added.

And then we look at returning patients, but I think it’s more that we kind of now try to see how fat we can get and how many we can get through the funnel rather than looking at new metrics. 

John Koetsier: How’s that growth impacting your retention? Is your retention level changing? Increasing? Decreasing? 

Ruth Guthoff-Recknagel: What would you think, it’s a health tech company. What would you think? What would your impression be?

Peggy Anne Salz: I would be for up. 

John Koetsier: Yeah, especially in COVID, I would be for up as well.

Peggy Anne Salz: I would be for increase. 

Ruth Guthoff-Recknagel: I think that the challenge you have, if it’s with healthcare, you need to have people sick to come back, right? 

John Koetsier: Yes.

Peggy Anne Salz: Okay.

Ruth Guthoff-Recknagel: So you would actually assume within the time frame we’re looking at that retention is dropping. I don’t have an impression yet how lifetime value will look like, but I’ve seen that the average of retention is within a month 30, 40% is the retention. Those are customers — sorry, patients — coming back, and that’s strong. And that number hasn’t even changed now that the U.K. has opened up again.

So we’ll see once COVID phase two is coming in, how that’s going to look like. But so far we’re going strong, even though we haven’t brought in new services yet.

John Koetsier: Wow.

Ruth Guthoff-Recknagel: But that’s the next story maybe.

Peggy Anne Salz: So still a fairly fat funnel, right? We’ll say plump, maybe that’s the word for it. Just at the top of my head. I’m just curious, because I was thinking about the balance with your ecosystem because that’s what’s challenging here, you know, you’re working with different companies and I’m sure they want fat. They don’t want plump.

So how are you sort of keeping that balance that it’s not too much overwhelming your model and your strategy? You know, sort of like that balance, if you will, between fat, bloated, plump, all these different adjectives we’ll bring into play. But how do you do that? How are you able to keep that balance?

Ruth Guthoff-Recknagel: So what we’re kind of doing is we look at the patient’s perspective. So we’ve built a bridge from primary to secondary care. And then the next bridge we’re building is from acute care, because right now you would only call us up when you have something urgent happening, is that we’re now also building the bridge to long term care.

And then hopefully later then it will also be preventive care, which means then that we go along the health journey and it starts with you as a baby, because you can be dependent all the way through. And I don’t know where it will end, but I think that that’s how we want to tackle it because it’s always about you enabling you to manage your health. If that makes sense. 

Peggy Anne Salz: Yeah, yeah. 

John Koetsier: That makes a ton of sense. Absolutely. So, you’ve had this uber growth which is always wonderful for a company to have. It’s not wonderful to have the circumstances around it obviously, but you know, that’s not going to continue forever. Those huge numbers never continue forever. So you’re prepping for that, you’re focusing on product. What’s your thinking? How are you refining the product to keep that retention and to stay relevant as the flood, as the fat funnel gets thinner. 

Ruth Guthoff-Recknagel: I think, so we have a few products or services down in the pipeline. So one of them is for example, mental health, because especially in England, there’s a lot of understanding around mental health. And that is, like I said earlier, that’s one that has long term care, and that also ties with other illnesses you might have.

And another one is virtual specialists, so we want to offer you more abilities to talk to specialists. And I think even further down the line, it could be that while we’re in lockdown it’s all virtual, but when it’s then not a lockdown, the same GP can then talk to you face to face.

So that’s the ideas we currently have, and now we’ll need to see what we can, which one we’re going to use. And we will talk to our patients for sure to figure out what they need, right? 

John Koetsier: Yes. 

Peggy Anne Salz: And of course, all of the thinking behind this, you know, I’m thinking about the what’s coming together in product marketing, focus on retention. I said at the top of the show, you were also in the Reforge course. I remember because you told me about it and got me very excited about it even before we had him on this show.

I thought we’ve really nailed it because this is an important course. I’m just curious, you know, what has happened to your thinking? How has it evolved since having that course with Brian Balfour? 

Ruth Guthoff-Recknagel: I think I even did a double whammy there because I first took the growth one, and then I realized within the growth class that actually retention is even more important for us.

So I then took the retention class and I think my biggest learning was, and that’s one of Brian’s saying, “Growth is good, but retention is forever.” And I think this always sticks in my head whenever we build something, I’m already thinking about loops.

And one other learning I took away is there is no perfect model. And you will need to keep iterating and you will need to adjust to kind of be as good as you can be, but there’s no perfect model. And I think also one of the benefits from this is there’s a community and you can kind of, you can talk to the community and see what others are thinking, and I think a lot of them are taking the same learning as I do. 

John Koetsier: That is super interesting, and it’s also great to be able to ask you this question, because you’re not just a growth marketer, you’re not just a founder and entrepreneur, you’re also a product person, right? And so as you look at where your path forward lies and you start mapping out product or market expansion, what’s that look like for you? How do you structure it to achieve it? 

Ruth Guthoff-Recknagel: I think, so the things we’re doing is we’re going along a line of what is the next big thing we want to achieve? And there’s a combination of, we have a North Star Metric, in our case it’s …  it’s sorry, consultations per month … I forgot the North Star Metric. 

John Koetsier: Haha, it’s all good.

Peggy Anne Salz: There’s a quiz later, Ruth! 

Ruth Guthoff-Recknagel: And I think what we also do, we have OKRs, so we’re trying to align them also with the product strategy. So for example, I know we’re ready for Q4, a big part of the product strategy will be scalability. So what will happen?

We have the North Star Metric, we look into the product strategy and then we recreate our OKRs along that line. And that gives us the power to think across the entire business and aligned to focus, and hopefully that will be very successful and only the numbers will show. 

John Koetsier: Yeah, very, very interesting. One of the things that Peggy and I always ask about as well is your tech stack, your growth stack. What’s that look like for you? What tools do you mostly use? 

Ruth Guthoff-Recknagel: We’re changing a lot of the tools right now, so I can tell you what we’ll soon be using.

So we are currently implementing Braze for marketing, Amplitude, and we’re also looking at OKR in order to track our OKRs better, because we use Confluence, like so many of us will start with, so we were POCing Perdoo.

I think those are the main ones that we’re currently changing. The rest is lots of Microsoft stuff, and let’s not talk about that. 

John Koetsier: Why not?

Ruth Guthoff-Recknagel: I think, they’re sometimes a hassle because you’re starting there rather than going wild. I think that’s …  let’s leave it at that. 

John Koetsier: Okay. Okay.

Peggy Anne Salz: I do have to ask though, because you’re changing it. So this is exciting, to find out later how you change it and why. Because another thing we’re looking at, John, if you think about that growth stack, I mean, it’s huge and it’s that chart we love, you know, the 30 across here and the 10 down here, and the 100 … 

John Koetsier: Love or hate, I’m not quite sure.

Peggy Anne Salz: I don’t know, it’s just huge. And we ask ourselves, and I’m asking more marketers this too as well, because of the times we’re in, you look at it and you say, is there anything that can be — I don’t say anything we can get rid of — but maybe simplify or just skip for the moment, put on hold, because I think that’s an ideal growth stack for ideal times. We’re not in those.

So, as a followup to that, Ruth, I mean, you’re looking at it again. Are you looking at it and saying there’s any part of that can be done differently or maybe a little scrappy for now, that you could maybe share some insights there? 

Ruth Guthoff-Recknagel: I think with some of the tools we have already done scrappy, and now because we’re growing so fast what we need to do is we need to take that learning and actually implement it in a much more powerful and much more segmented way.

I think, if you look at cohorts, if you look at personalization, that’s super important in the health sector.

So I think at the moment, we’re not doing scrappy because this is health, and it’s highly regulated and you need to be super careful. I think what we’d rather, and let’s maybe go into that direction when we implement a product, and you might be familiar with currywurst, right?


Peggy Anne Salz: Oh, yeah.

Ruth Guthoff-Recknagel: It’s German sausage and it’s cut in slices… 

Peggy Anne Salz: Oh yeah, it was the thicker accent, got me there. I say “coryvorst.” 

Ruth Guthoff-Recknagel: What do you mean a thicker accent? I don’t have a German accent. 

John Koetsier: Somebody will have to translate that for me. 

Peggy Anne Salz: No Ruth, no way. It’s this amazing bratwurst that comes with a curry sauce that is to-die-for, I’m sorry. Yes. 

John Koetsier: Okay.

Ruth Guthoff-Recknagel: So I think, and then, so what happened with that currywurst or whatever we built, or the new processes we implement, we’re looking at the different slices. And so we were implementing things very thinly. And the first slice, for example, for mental health will be very simple …  second slice, third slice. And that’s when we get more toolings in and that’s when we get the product faster, but you start really thin, I think. So I wouldn’t call it scrappy, I would call it minimal… 

Peggy Anne Salz: Alright.

Ruth Guthoff-Recknagel: …and minimal in … you’ve just talked about them. And I think that that’s more important than scrappy, if that makes sense. 

John Koetsier: I can’t wait til we get to the Oktoberfest part of your tech stack. 

Peggy Anne Salz: I’m just going to translate. We actually were talking about the salami approach to the growth stack is what we were doing… 

John Koetsier: Ah, okay, excellent. 

Peggy Anne Salz: …little thin slices. You could have done a club sandwich, but we won’t go there, even though it is around… 

John Koetsier: German, Italian, come on guys, can we speak English here? Haha.

Peggy Anne Salz: … food. It’s the language of food, John. I think that’s what it is. But it is interesting to learn about that. I mean, you have amazing times ahead for your company. You’re building on that product. You’re going to be building other journeys too, that’s going to be exciting as well.

You know, how do you plan to stay on top of this growth? You also have your partners, who have their thoughts around what type of business they want to be generating. Keep us all on the same page, that’s what you need to do. And also hit some targets at the end of the day. Your OKR is how do you …  I won’t ask how are you going to do it, because that’s a tough one, but maybe you can tell me something about how you plan to approach that. 

Ruth Guthoff-Recknagel: I think once again, it’s along the health journey, and because it’s around the patient and that will then enable us to find the right services.

And if we then think about fat funnel, we think about currywurst and just the right slices to figure out what our patients want, then we will also be able to sell that to the companies. And I think that that’s our way forward right now. 

John Koetsier: Excellent. Ruth, this has been amazing. Want to thank you so much for joining us on Retention Masterclass. 

Ruth Guthoff-Recknagel: No worries. Thank you for having me. 

Peggy Anne Salz: It’s been amazing, Ruth. I have to chime in there because you’ve given us some great analogies I don’t think we’ll forget, for a while. But also some great lessons and some plain talk because you have to make some tough choices. Just exciting to have you here and it’ll be great to have you maybe back at some point with a different menu, John, I’ll say. [Laughter]. Won’t go there, pun intended… 

John Koetsier: A culinary update.

Peggy Anne Salz: Culinary update, pun intended, but great to have you here. Thanks for sharing. 

Ruth Guthoff-Recknagel: Thank you. Auf Wiedersehen.

John Koetsier: And for everybody else, whatever platform you’re on, hey, like, subscribe, share, comment, or all the above. If you love the podcast, please rate it, review it, that’d be a massive help. 

Peggy Anne Salz: And I have to say, John, you know, we can sort of start pre-promoting, we will be going live social soon. I think we need to mention that. 

John Koetsier: We will, we will.

Peggy Anne Salz: Yes we will.

John Koetsier: Live social, it’s going to be exciting. Live on LinkedIn, Twitter, maybe a few other platforms, possibly YouTube. We’ll see how it goes. 

Peggy Anne Salz: Yeah. 

John Koetsier: And every mistake will be highlighted and forever available, haha. 

Peggy Anne Salz: And we can do the blooper reel. We can do the roll at the end, you know, of all the things that we don’t do quite right. And more channels to see everyone and connect with everyone, going to be very exciting. So until next time, on all the different channels, keep well, stay safe. I’m Peggy Anne Salz here for Retention Masterclass, signing off. 

John Koetsier: And I’m John Koetsier, have a wonderful day.